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Year 2- CNC exam > Cardiac conditions > Flashcards

Cardiac conditions Flashcards

1
Q

Risk factors

A
  • FHx
  • hypertension
  • high cholesterol
  • obesity
  • diabetes
  • smoking
  • advanced maternal age
  • multiparity
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2
Q

Symptoms

A
  • breathlessness at rest, severe breathlessness or syncope on exertion
  • difficulty breathing when lying down (orthopnea) or during night
  • palpitations, chest pain (especially during exertion)
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3
Q

signs

A
  • syncope
  • haemoptysis –> coughing up blood
  • irregular pulse, persistent tachycardia
  • isolated systolic hypertension
  • heart murmur
  • neck vein distention
  • change in heart sounds
  • clubbing
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4
Q

5 S+S that are not part of normal pregnancy

A
  • SOB when lying flat
  • chest pain
  • tachycardia
  • high resps
  • fainting on exertion
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5
Q

Maternal complications

A
  • decompensation in pregnancy
  • pre eclampsia
  • permanent decline in cardiac function
  • death
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6
Q

Fetal complications

A
  • prematurity
  • IUGR
  • IUD/neonatal death
  • increased risk of CHD
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7
Q

Non-invasive monitoring

A
  • BP monitoring via cuff
  • heart rate
  • temperature
  • oxygen sats
  • resps
  • capillary refill
  • ECG
  • AN check and CTG >26/40, or PN check
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8
Q

Invasive monitoring

A
  • arterial line
  • central venous pressure
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9
Q

Blood tests

A

FBC
U+Es
Clotting
LFT
Arterial blood gases
Troponin level –> protein released from heart during heart attack
BNP –> hormone builds up from pressure in heart during heart failure

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10
Q

Investigations

A
  • auscultation of heart sounds
  • echo
  • chest x-ray
  • 24 hr holter ECG
  • cardiac CT
  • MRI
  • coronary angiogram
  • exercise testing
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11
Q

ASD + VSD
- definition
- S+S

A

hole in the atrial septum or ventricular septum
most common form of CHD

S+S: feeding difficulties, poor weight gain newborn, irritability, excessive sweating, cyanosis.

Generally tolerates pregnancy well unless large and untreated

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12
Q

Patent ductus arteriosus (PDA)

A

persistence of a normal fetal structure between the left pulmonary artery and the descending aorta bypass pulmonary circulation.
Presence beyond 10 days of age abnormal and needs repair.

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13
Q

Tetralogy of Fallot

A

4 structural anomalies: VSD, pulmonary valve stenosis, right ventricular hypertrophy, overriding aorta.

Can be diagnosed antenatally during USS and/or fetal echo.
Sometimes associated with chromosomal abnormalities.

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14
Q

ToF S+S and treatment

A

Tet spell = arterial oxygen saturation drops markedly after feeding, crying or being agitated.
Heart murmur, cyanosis/low sats, unresponsiveness, poor weight gain.

Treatment: flex the knees forward and upward to increase the blood flow.

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15
Q

Coarctation of the Aorta (CoA)

A

a narrowed portion of the aorta, that forces the heart to pump harder to get blood through the aorta and onto the rest of the body.

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16
Q

Differential diagnosis for CoA

A

PIH

17
Q

Maternal and fetal complications/risks of CoA

A

Maternal: hypertension –> increasing risk of PET, miscarriage, heart failure, rupture of aorta, stroke.

Newborn: if severe, will develop severe heart failure in first few days. Additional signs; pale/grey, poor feeding and weight gain, cold feet or legs, lower BP in lower limbs.

18
Q

Transposition of the Great Arteries (TGA)

A

aorta and pulmonary artery are swapped around. Deoxygenated blood not pumped to lungs for gas exchange and oxygenated blood not being pumped to the body. A baby will benefit from ductus arteriosus being open to mix blood (but this closes around 1 week)

19
Q

S+S of TGA

A

difficult to see on USS
cyanosis in first few hours of life
babies more likely to be premature or SGA

20
Q

3 severe congenital heart defects which carry significant risk

A
  • unoperated cyanotic (ToF) or complex CHD (univentricular conditions)
  • cardiomyopathies
  • pulmonary hypertension (can also be acquired)
21
Q

Valve stenosis

A

valve opening is narrower than normal. poorly tolerated in pregnancy (especially mitral/aortic)

22
Q

Valve regurgitation

A

valve is unable to close properly, allowing blood to flow back into the previous chamber. mild to moderate regurgitation is tolerated in pregnancy if good heart function.

23
Q

apart from age or underlying conditions, what else can valvular heart disease be a result of?

A

rheumatic fever
develops after throat infection by group A strep –> antibodies cause inflammation and swelling of the heart valves. when they heal, thick tissue is deposited resulting in stenosis.

24
Q

Endocarditis

A

bacterial infection that causes endocardium of heart to become inflamed, causing valve damage eg. stenosis
Most likely when there is a prosthetic heart valve.

25
Q

Prosthetic heart valves

A

bioprosthesis –> short longevity, can deteriorate in pregnancy, require anticoagulation

mechanical –> durable, high risk of thrombosis, require life long anticoagulation.

26
Q

Aortic dissection

A

when the lining of the aorta tears and the blood flow escapes between the layers of the aortic vessel wall. Rupture of the aorta can follow, resulting in death from excessive blood loss.

27
Q

Marfan’s syndrome

A

genetic disorder of connective tissue.
issues include: aortic dilatation and aneurysm, aortic dissection.

28
Q

Loeys-Dietz syndrome

A

genetic disorder of the connective tissue.
high risk of aortic aneurysm and dissection and also ASD, PDA

29
Q

Ehlers-Danlos syndrome

A

inherited condition affecting connective tissue. With vascular EDS, blood vessels are fragile and there is risk of aortic aneurysm and dissection.

30
Q

Peripartum cardiomyopathy (PPCM)

A

pregnancy-specific form of dilated cardiomyopathy, presenting with heart failure between 36/40 and 6 months postnatally, in the absence of a prior cause.

31
Q

Arrythmias
what are they?
red flag conditions?
possible cause

A

any variation from the normal regular rhythm of the heartbeat (tachycardia, bradycardia, SVT)

red flag conditions: Brigade syndrome, Long QT syndrome, Wolf-Parkinson-White syndrome.

caused by abnormal concentrations of potassium in the blood.

32
Q

Ischaemic heart disease

A

due to inadequate myocardial blood flow related to coronary arterial narrowing.
Temporary–> angina pectoris
Permanent–> myocardial infarction

33
Q

S+S of IHD
esp. what it can be confused with in pregnancy

A
  • chest pain radiating to left arm or jaw
  • feeling of constriction
  • sweating
  • nausea
  • feeling of impending death or collapse
    confused with heartburn and innocent breathlessness, and/or masked during labour
34
Q

Women with which conditions would be advised against pregnancy?

A

pulmonary hypertension
aortic coarctation complicated by dissection or dilatation

35
Q

Antenatal care

A
  • midwife to refer to cardiac clinic
  • increased risk of PET - regular BP and urinalysis
  • optimise Hb level to prevent anaemia
  • medication r/v- eg. warfarin teratogenic in 1st trimester
  • high risk of IUGR–> regular USS
  • fetal echo at 16/40 if Fox or maternal CHD
36
Q

Intrapartum

A
  • SVD preferable (CS associated with blood loss, infection and puerperal fluid shifts)
  • may be beneficial to plan IOL for staffing
  • CS indicated if aortic dilatation > 40mm, or aneurysm present
  • preterm –> corticosteroids, care needed as associated with fluid retention –> decompensation
  • Lateral/upright position –> reduce aortocaval compression (or a wedge if supine is required)
  • epidural –> to reduce physiological increase in cardiac output in labour, minimise exertion.
  • fluid balance –> to ensure no hypovolemia/hypervolemia.
  • Oxytocin safe to use although may need to be concentrated to avoid fluid overload.
  • CEFM –> poor uteroplacental perfusion, pre term
  • allow 2 hrs passive 2nd stage
  • avoid Valsalva manoeuvre as it can increase BP
37
Q

Immediate PN

A
  • oxytocin 3rd stage (avoid ergo, misoprostol, haemobate/carboprost)
  • regular obs –> after placenta separation, there is an increased intravascular volume. Women could be compromised by fluid shifts. o2 sats can help identify pulmonary oedema.
  • analgesia –> ensure no tachycardia from pain
  • LL
  • CVP or arterial line might need to continue
  • v high VTE risk - anticoagulants
  • some drugs contraindicated in BF
38
Q

Dx to community

A
  • NIPE prior to dx
  • plan for follow up care
  • GP appt at 2 weeks and 6 weeks, plus cardiologist r/v
  • contraceptive advice
39
Q

medications

A

aspirin
labetalol / bisoprolol
nifedipine
digoxine (PN only)
diuretics (furosemide)
anticoagulants (warfarin, LMWH)

Year 2- CNC exam (14 decks)

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