11.2a Cardiovascular Disorders

Question 1

Cardiac Changes

Answer 1

• Pregnancy causes major cardiovascular changes. The ones that affect patients with cardiac disease are..
• Increased intravascular volume
• Decreased systemic vascular resistance
• Cardiac output changes
• Intravascular volume changes after birth that can persist for a few weeks
• Normal heart can compensate increased workload but diseased hearts can be hemodynamically challenged

Question 2

Cardiac Decompensation

Answer 2

• Inability for the heart to maintain a sufficient cardiac output
  (FEVER IS THE MAJOR CAUSE OF CARDIAC DECOMPENSATION IN PREGNANCY)
• Occurs when cardiovascular system cannot tolerate changes due to pregnancy. This is due to heart failure, myocardial disease, valvular disease, or congenital heart defects.

Question 3

Classifications of Heart Disease

Answer 3

Class 1 - Asymptomatic with no limitations of activity
Class 2 - Symptomatic with slight limitations of activity
Class 3 - Symptomatic with marked limitations of activity
Class 4 - Symptomatic with inability for any physical activity without discomfort

• Classifications are used to determine the type of treatment needed.
• Functional classification of disease is assessed at 3 months and 7-8 months gestation

Question 4

Cardiac Disease Groups

Answer 4

Group 1 - Low mortality rate (<1%)
Group 2 - Medium mortality rate (5-15%)
Group 3 - Higher mortality rate (25-50%)

Question 5

Diagnosis of Heart Disease

Answer 5

• History
• Physical Exam
• Radiographic Findings
• ECG
• Holter Monitor
• Ultrasonographic Results

Question 6

Pregnancy Complications

Answer 6

• Maternal arrhythmias
• Heart Failure
• Preterm Birth
• Fetal Growth Restriction
• Small Risk for Maternal/Fetal Death
• HIGHEST RISK OF DEATH/COMPLICATIONS ARE IN THOSE WHO HAVE PULMONARY HYPERTENSION, COMPLICATED COARCTATION OF THE AORTA AND MARFAN SYNDROME WITH AORTIC DEVELOPMENT

Question 7

Marfan Syndrome

Answer 7

• Affects connective tissue of the body