Table 4.

Parameters for identification of critical illness in the parturient with cardiac disease

Symptoms	Palpitations at rest, edema, dyspnea (progressive, paroxysmal nocturnal dyspnea, rest), chest pain (exertional or rest), syncope (exertional)
Signs (Examination)	Bradycardia (heart rate <50/minute), tachycardia, raised jugular venous pressure (JVP), cardiomegaly, right ventricular heave, loud P2, gallop rhythm, loud systolic murmur (intensity >3), diastolic murmur, cyanosis, crepitations, persistent pedal edema (unresponsive to limb elevation)
Investigations	Electrocardiogram (ECG), Holter, event monitor Doppler echocardiography Transesophageal echocardiography (TEE) Stress testing Cardiac catheterization/angiography Cardiac magnetic resonance imaging (MRI)	Detect arrhythmias Assess VHD, pulmonary artery systolic pressures, cardiac function Detect atrial thrombi, atrial septal defect, endocarditis, aortic dissection Assess severity of valve disease, detect ischemia, provoke arrhythmia Diagnose and treat coronary artery disease Assess whole aorta, congenital heart disease, myocardial disease
Monitoring	Noninvasive Invasive	ECG, Holter, natriuretic peptide tests [blood levels of B-type natriuretic peptide, BNP; N-terminal (NT)-prohormone BNP, NT-proBNP], transthoracic echocardiography Doppler echo Invasive blood pressure (IBP), central venous pressure (CVP), pulmonary artery catheter (PAC) derived values, TEE, esophageal Doppler