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BMJ 2007;335:1042-1045 (17 November), doi:10.1136/bmj.39365.655833.AE
E Gelson, clinical research fellow1, M Gatzoulis, professor of cardiology2, M Johnson, reader in obstetrics and obstetric medicine1
1 Academic Department of Obstetrics and Gynaecology, Imperial College London, London SW10 9NH , 2 Adult Congenital Heart Centre, National Heart and Lung Institute, Royal Brompton Hospital, London SW3 6NP
Correspondence to: E Gelson egelson@imperial.ac.uk
Valvular disease may be unmasked in pregnancy when physiological changes increase demands on the heart. Women with valvular heart disease require close follow-up during pregnancy, delivery, and postpartum
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Valvular heart disease may present for the first time in pregnancy as the increasing demands on the heart lead to decompensation and cardiac failure. However, the diagnosis is not always easy as the symptoms of pregnancy (tiredness, shortness of breath, and palpitations) can mask those of deteriorating disease. Moreover, in the United Kingdom, a decline in rheumatic fever means that valvular heart disease is now rare, and doctors—particularly general
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