Cardio-Obstetrics Clinic

Overview

Pregnancy can be an exciting time in life. However, it can also be a time for uncertainty if you have:

• A heart condition and want to become pregnant.
• A heart condition and have an unplanned pregnancy.
• Become pregnant and started to have symptoms of heart disease.

The Cardio-Obstetrics Clinic at Cleveland Clinic brings together specialists from cardiovascular medicine, obstetrics/gynecology, cardiovascular surgery, genetics, specialized imaging and nutrition to offer:

• Evaluations for people with heart disease to determine safety of pregnancy.
• Evaluations of pregnant people with symptoms of heart disease.
• Genetic counseling for people with heart disease to determine the risk of disease in their child.
• Care of pregnant people with heart disease throughout their pregnancy and delivery.
• Diagnosis, monitoring and treatment related to problems identified through fetal monitoring.

What We Treat

Patients seen in the Cardio-Obstetrics Clinic have a variety of medical conditions and reasons for treatment that may affect their personal health and safety or the health and safety of the fetus.

Some of these conditions include:

• Congenital heart disease and/or prior treatments.
• Heart diseases, such as cardiomyopathy, hypertrophic cardiomyopathy (HCM), valve disease, coronary artery disease, arrhythmias and aorta disease.

Learn more about:

• Heart disease and pregnancy.
• Marfan syndrome and pregnancy.

Our Doctors

Our team of specialists in obstetrics and cardiovascular disease include:

Cardiology and Adult Congenital Heart Disease

• Margaret Fuchs, MD
• Joanna Ghobrial, MD
• Kenneth Zahka, MD (also Pediatric Cardiology)

Heart Failure

• Karlee Hoffman, DO

General Cardiology

• Deirdre Mattina, MD (Beachwood location)

Electrophysiology

• Peter Aziz, MD
• Mohamed Kanj, MD

Maternal Fetal Medicine

• Katherine Singh, MD (OB Director of Cardio-OB clinic)
• Stephen Bacak, DO
• Justin Lappen, MD
• Cara Dolin, MD
• Adina Kern-Goldberger, MD

Thoracic and Cardiovascular Surgery

• Hani Najm, MD
• Eric Roselli, MD
• Shinya Unai, MD
• Tara Karamlou, MD

Cardiothoracic Anesthesia

• Karen Steckner, MD

Vascular Medicine

• Jay Bishop, MD
• Marcelo Gomes, MD
• Scott Cameron, MD

Our team also includes cardiovascular specialists in other areas to meet each patient’s individual needs.

Neurology

• Elizabeth Aradine, DO

Pulmonary Hypertension

• Neal Chaisson, MD
• Gustavo Heresi, MD
• Anthony Cucci, MD

Cardiovascular Clinical Genetics

• Christina Rigelsky, MS, CGC
• Diane Clements, MS, CGC
• Paul Crawford, MS, CGC
• Joseph Liu MS, CGC

Nutrition

• Julia Renee Zumpano RD, LD
• Katherine Patton, MEd, RD, CSSD, LD

Coordinators

• Debbie Toth
• Samantha Nedlik

Appointments

Make an Appointment

The Cardio-Obstetric Clinic is located at Desk J2-4, on the second floor of the Sydell and Arnold Miller Family Heart & Vascular Institute (J Building).

To make an appointment, please call the Fetal Care Center at 1.866.864.0430 or 216.444.9706.

Before your appointment

If your appointment is scheduled more than a week away, you will need to send in your records, including medical history, test results and films (such as echocardiogram, ultrasound, chest X-ray, MRI or CT scan). All records should be sent to the physician you will see in the Cardio-Obstetrics Clinic. Send all information in the same package (clearly marked with your name and address) via Airborne Express, Federal Express or certified U.S. mail (make sure you have a tracking number). The address is:

Cardio-Obstetrics Clinic
Fetal Care Center
Cleveland Clinic
9500 Euclid Avenue – Desk M8309
Cleveland, OH 44195

If your appointment is scheduled within a week, please bring your records to your appointment.

What to expect during your appointment

Please arrange to stay in the Cleveland area for one to two days to complete your appointment and testing.

First, you will meet with a nurse who will collect your information, and ask questions about your medical history.

Based on your condition and history, you may need an electrocardiogram (ECG), echocardiogram (echo), blood tests, ultrasound, exercise stress testing, arrhythmia monitoring, and other tests.

Next, you’ll meet with a cardiologist and an obstetrician/gynecologist who will review your information and test results and do a physical exam. You will also meet with a genetic specialist and nutritionist. Your team will provide you with an assessment and care plan.

If you need to meet with other members of the Cardio-Obstetrics team, your appointment(s) will be scheduled before your visit or during the same day.

Follow-up

Your team will let you know how often you need to have follow-up appointments. These follow-up appointments will be based on your evaluation and treatment plan. There's an opportunity for telephone follow-up as well.

Travel to the Cleveland Clinic

We want to make traveling to Cleveland Clinic as easy as possible. For helpful information:

• Information on travel to the Miller Family Heart, Vascular & Thoracic Institute.

Physician Referrals

Request an evaluation for your patient Mon. - Fri., 8 a.m. - 5 p.m. (ET): call toll-free 800.659.7822.

• More information on referrals.

Postpartum Heart Clinic - Shared Medical Appointment

Overview

The Postpartum Heart Clinic is for parents who are two to six weeks postpartum and have a:

• History of chronic hypertension during pregnancy, gestational hypertension, preeclampsia, eclampsia or HELLP syndrome.
• History of gestational diabetes.
• Body Mass Index (BMI) higher than 50.

Appointments

Appointments in the Postpartum Heart Clinic are shared medical appointments (SMAs) and take place at the Beachwood Family Health Center. Each appointment is 1.5 hours long with a physician and nurse practitioner who will provide care and education for you.

What is a shared medical appointment (SMA)?

Physicians and other healthcare professionals are always seeking better ways to offer access to high-quality care to our patients. SMAs offer an innovative, interactive approach to healthcare that brings patients with common needs together with one or more healthcare providers.

• More information on shared medical appointments.

Resources

Hypertension and Pregnancy

Hypertension and hypertensive disorders in pregnancy

Hypertension is high blood pressure. In pregnancy, there are five types of conditions that involve high blood pressure. They’re also referred to as hypertensive disorders in pregnancy (HDP). These include:

• Chronic hypertension: High blood pressure that starts before the 20^th week of pregnancy.
• Gestational hypertension: High blood pressure that starts after the 20^th week of pregnancy.
• Preeclampsia: High blood pressure that starts about midway through pregnancy along with at least one of these other issues:
  • Protein in the urine.
  • Kidney problems.
  • Liver problems.
  • Blurred vision.
  • Shortness of breath.
• Eclampsia: The same symptoms as preeclampsia along with seizures.
• HELLP syndrome: Life-threatening type of preeclampsia that also includes breaking down of red blood cells (hemolysis) low platelet counts and elevated liver enzymes.

Risk factors for HDP

About 5% to 10% of pregnant people have HDP. The conditions are most common among people who are Black, Asian Indian and Alaska Native.

People are more likely to have preeclampsia with their first pregnancy. Other risk factors include:

• Chronic hypertension.
• Chronic kidney disease.
• Lupus.
• Diabetes.
• Pregnancy that involves more than one fetus.
• Family history of preeclampsia.
• Obesity.

Effects of HDP

Hypertensive disorders in pregnancy can cause serious problems, including life-threatening situations for you and your fetus. Parents who have HDP can have long-term complications, including cardiovascular disease at an early age. Because of this, it’s very important to have specialized care that ideally includes a pre-pregnancy consultation if you are at risk of developing HDP.

Preeclampsia and Eclampsia

If you have preeclampsia or eclampsia, your provider will work with you to find a treatment plan that matches your needs. Your provider may prescribe magnesium to prevent seizures and medicine to control your blood pressure. In many cases, these conditions don’t last beyond delivery. But, some people do continue to have high blood pressure after giving birth.

Preeclampsia also increases the risk of cardiovascular disease. People who have preeclampsia are more likely to have cardiovascular disease years after pregnancy. Two out of three women who have preeclampsia will die from heart disease. These risks can be reduced through lifestyle changes and following a plan of care to reduce risk factors.

Cardiovascular Disease in Women.

Coronary Artery Disease.

Gestational Diabetes (gDM).

Heart Failure in Women.

Low Sodium Diet.

The Mediterranean Diet.

Exercise Tips.

More Information

Online Resources

• Heart Disease and Pregnancy.
• Cleveland Clinic Fetal Care Center.
• Maternal Fetal Medicine.

News

• Heart issues are among the top reasons women die in childbirth, Dr. Majdalany 2/22/2019.
• Cleveland Clinic offers new heart treatment for mom’s to be, Dr. Chapa, 2/1/2017.
• Marc: Congenital Heart Disease, Dr. Majdalany, 3/3/2016.

Need More Information?

• Contact us
• Speak with a nurse

Or call the Sydell and Arnold Miller Family Heart, Vascular & Thoracic Institute Resource & Information Nurse at 216.445.9288 or toll-free at 866.289.6911. We would be happy to help you.