11. Pregnancy and cardiovasular diseases

Question 1

what can be seen in a pregnant women that had a rheumatic heart disease?

Answer 1

mitral stenosis most commonly

Question 2

asymptomatic pregnant patients that have RHD can develop?

Answer 2

symptoms of cardiac decompensation or pulmonary edema as pregnancy progresses.

Question 3

what is expected in a pregnant patient with a congenital heart defect?

Answer 3

If the anatomic defect has been corrected during childhood with no residual damage, the patient is expected to go through pregnancy without complications.

Question 4

pregnant patient that develops atrial fibrillation during pregnancy is in high chances of experiencing..

Answer 4

congestive heart failure

Question 5

what is the management of atrial fibrillation in a pregnant women

Answer 5

Anticoagulation (LMWH) if fibrillation cannot be aborted by physical maneuvers, pharmacological antiarrhythmics, or electric-cardioversion.

Question 6

what is done in a pregnant patient with a known cardiac arrhythmia disorder?

Answer 6

frequent monitoring with ECG and Echo

Question 7

what drugs should be avoided in pregnant patients with ischemic heart disease?

Answer 7

ACE inhibitors and statins

Question 8

what should be administered in pregnant patients with IHD?

Answer 8

antiplatelet agents which are safe for the fetus

Question 9

what should be performed before pregnancy in a patient with IHD?

Answer 9

Stress testing and angiography

Question 10

what is the most serious risk factor for maternal morbidity and mortality during pregnancy?

Answer 10

pulmonary hypertension (especially with Eisenmenger syndrome)

Question 11

when do deaths in pregnant women occur because of pulmonary hypertension?

Answer 11

most deaths occur during delivery or in the first weeks postpartum

Question 12

General management during pregnancy with heart failure

Answer 12

• Cardiologist referral during all stages of pregnancy.
• Serial F/U with ECG, Echo, BNP, BP measurement.
• Avoidance of excessive weight gain and edema.
• Avoidance of strenuous activity.
• Avoidance of anemia.
• Avoidance of infections.
• Anticoagulation when indicated (LMWH).
• Fetal echocardiography for women with a history of congenital heart diseases.
• Deliver vaginally unless obstetric indications for cesarean delivery are present.

Question 13

what is the treatment of CHF during pregnancy?

Answer 13

→ β-blockers, vasodilators, digoxin.

(ACE-i, ARBs, and MRA are teratogenic).