Cardiac Flashcards
Haemodynamic changes in pregnancy (4) and timing of peak effect
Increased blood volume Increased HR (10-20bpm) Increased CO (50%) Decreased TPR (40-70%) Peak effects late 2nd trim early 3rd
Marfan syndrome complications
Aortic regurg Aortic dissection and rupture Mitral valve prolapse Aortic dilatation can occur in pregnancy >45mm—dangerous
mitral stenosis complications
Mild is well-tolerated
HF commonly occurs 2nd trimester
Sustained AF-may ppt HF and thrombosis-embolus events
0-3% chance mortality
Nyha class>= II, systolic pap>30mmhg, severe stenosis, older ages—> maternal complications
If severe ms—> pre-pregnancy intervention
Mitral stenosis risks to baby
20-30% prematurity
IUGR 5-20%
FDIU 1-5%
Peripartum cardiomyopathy
Idiopathic cardiomyopathy presenting with heart failure secondary to LV systolic dysfunction towards the end of the pregnancy or in months following delivery, where no other cause is found ; ef <45%
Risk factors for peripartum cardiomyopathy
Age>30 Obesity Chronic htn Multips Multiple pregnancy Pet Low ses
Maternal cardiovascular changes
Increase in blood volume (50%) Increased plasma volume and rbc mass (20-30%) Haemodilution 500-1000ml BMI dependent
ECG changes in pregnancy
Left deviation of QRS axis
Prominent Q waves in lead II, III, and avF
Flat and inverted t waves in lead III, V1-V3
Peak shift in haemodynamics during pregnancy
24-72 hours after delivery
WHO class 1
Very low risk
Uncomplicated, small or mild pulmonary stenosis
PDA
Mitral valve prolapse
Successfully repaired simple lesions
Atrial or ventricular ectopic beats (isolated)
WHO class II
Low to moderate risk
Upoperated ASD or VSD
Repaired Tof
Most arrhythmias
Marfan syndrome without aortic dilatation
Aorta <45mm with bicuspid aortic valve or repaired coarctation
Mild LV impairment
HOCUM
Native or tissue valvular heard disease not considered WHO I
WHO class III
Mechanical valve Systemic RV Fontan circulation Cyanosis heart disease Aortic dilitation 40-45mm in marfan or bicuspid valve
WHO IV
Pregnancy contraindicated Pulmonary arterial HTN LV EF <30% Previous peripartum cardiomyopathy with any residual impairment of LV function Severe MS or severe symptomatic AS Marfan aorta >45mm Bicuspid >50mm Native severe coarctation
Left-sided obstructive lesions
AS
Coarctation
MS
Preload dependent
Patients prone to pulmonary venous congestion
Can develop AF
ECHO at 32/40 - peak haemodynamic load
Right-sided obstructive lesions
Pulmonary stenosis
Usually well tolerated
May be increased risk of PET
