Cardiac

Question 1

What are the 3 major cardiac changes in pregnancy?

Answer 1

1) increased blood volume
2) increased cardiac output
3) decreased systemic vascular resistance

Question 2

When does peak hypervolemia occur?

Answer 2

28-32 wks

Question 3

What is the effect of blood volume on CBC?

Answer 3

increased RBC –> decreased Hct –> physiologic anemia

Question 4

cardiac output calculation

Answer 4

CO = stroke volume x HR

Question 5

What occurs to HR?

Answer 5

mild tachycardia

15-20 bpm above baseline

Question 6

What precipitates the change in SVR?

Answer 6

decreased afterload @~5wks

Question 7

What changes are seen in BP?

Answer 7

decreased afterload BUT increased CO does not compensate –> drop in BP as early as 7th wk

Question 8

What are normal heart sound changes?

Answer 8

• Loud systolic flow murmurs
• Jugular vein distension
• Venous hum
• Mammary souffle
• S2 (second sound) P (pulmonary second sound) increased; S2 split
• S1 (first sound) M (mitral first sound) increased and widely split
• Aortic of pulmonary flow murmurs
• Occasional S3

Question 9

What are normal changes that mimic heart disease?

Answer 9

1) functional systolic murmurs
2) accentuated respiratory effort
3) edema in LE
4) fatigue and exercise intolerance
5) palpitations, SOB w/ exertion, chest pain

Question 10

What sx are indicative of heart disease?

Answer 10

• progressive dyspnea/orthopnea
• nocturnal cough
• hemoptysis
• syncope
• chest pain

Question 11

What are clinical findings that indicate heart disease?

Answer 11

• cyanosis
• clubbed fingers
• persistent neck vein distension
• loud systolic murmur (≥3/6)*
• diastolic murmur*
• systolic murmur that radiates to carotids*
• cardiomegaly
• persistent arrhythmia
• persistent split S2
• criteria for pulmonary HTN

Question 12

Which 3 sx should be investigated?

Answer 12

1) palpitations –> look for arrhythmia on EKG
2) chest pain –> EKG, troponin levels, CXR
3) SOB - look at whole picture + vitals –> CXR, EKG, echo

Question 13

What are normal EKG findings?

Answer 13

• +/- mild ST changes
• atrial and ventricular premature contractions
• leftward shift of QRS

Question 14

What should be part of physical assessment?

Answer 14

1) HR
2) weight gain
3) O2 sat

Question 15

Describe effect of heart disease on fetus

Answer 15

worsening heart function –> decreased O2 to tissues (i.e. placenta) –> decreased O2 to fetus –>

1) IUGR
2) NRFHT

Question 16

What is the most common cardiac disorder in pregnant people?

Answer 16

mitral valve prolapse

Question 17

What are sx of MVP?

Answer 17

*usually asymptomatic

• dizziness
• palpitations
• faintness
• dyspnea
• chest pain

Question 18

How is MVP dx’ed?

Answer 18

echo

Question 19

What are complications of MVP?

Answer 19

• mitral regurgitation
• rupture chordae tendineae
• infective endocarditis
• sudden death

Question 20

What are myxomatous changes in MVP?

Answer 20

redundant, thickened mitral leaflets –> more prone to deformity, infection

Question 21

What is tx for MVP?

Answer 21

*if symptomatic

β- blockers

• decrease sympathetic tone
• relieve chest pain and palpitations
• reduce risk of life-threatening arrhythmias
• BUT! Fetal safety!

Question 22

How should bacterial endocarditis be managed?

Answer 22

routine abx prophylaxis NOT recommended