Cardiac Conditions Flashcards
Congenital
Present from birth
Acquired
Devolops over time
Why is cardiac disease important
One of leading causes of mbrrace - 13%
Risk greatly increases with ages
Half who died came from poorest quintile
Leading causes of maternal death in the uk for more than 20 years
Women are largely dying from acquired heart disease
Pre pregancy counselling for known cardia conditions
MDTinput led by cardiologist
Involvement of obstretric Ian’s
Considerations as to whether o get pregancy and when to get pregnant
Health optimisiation
Pregnancy not recommended in cases of
Pulmonary hypertension - high blood pressure in the pulmonary arteries
Eisenmenger syndrome - abnormal blood flow to the lungs caused by a congenital heart defect
Ehlers Danilo’s vascular - type of connective tissue disorder that has a high risk of blood vessels rupturing
Severely stenotic valve - thickening narrowing of heart valve affect blood
Booking appointment
Thorough history taking regarding medical and family history
Referral fo multi displinary consultant les care to known or suspected cardiac condition
Risk assessment of VE
Arrange medication review if required
Ongoing AN care for known cardiac conditions
As per mdt plan
Enquire and record medication adherence or changes
Discuss cardiac related symptoms and refer urgently - chest pain, breathless ness, tachy, generally unwelll - ambulance A&e
Provide emotional ans physical support in managing a complex pregnancy
Medical interventions
Commonly used medications can have potential side effects for women with cardiac conditions
Prescriber must weigh Ip te risks and benefits of each drug
The midwife should be alert for signs of adverse effects and call for help urgently
Mode of birth
Most women ith cardiac conditions Prescriber must can aim for a vaginal birth
Limit active 2nd stage cardiac reasons for a c section
- aortic disease
- recent warfarin
- left ventricular
Principle of intrapartum management
Keep it low stress
Regular observation
Good pain control
Prefect fluid balance
Avoid hypovoleamia / significant blood loss
Multi displinary
Maintain some normally
Most common congenital heart disease
Atrial septal defect - the septum does not develop normally eating a hole between the two atria
Ventricular septal defect - septum doesn’t develop normally leaving a hole between the 2 ventricles
Patent ductus arteriosus - hole between arts and pulmonary artery
Patent foramen o ale- the temporary ole does not close between the atria. Usually smaller than a ASD if the hole are relatively mall, pregnancy is usually not problematic
Other congenital conditions and pregnancy
Stenotic valve - valves are abnormally narrow, causing impaired blood flow. Can affect any valve. May enquire surgical intervention before pregnancy to reducee risk. Can include mechanical r porcine valve
Marian syndrome - 80% of women with Marian’s have some cardiac involvement commonly issue with mitral valve. At risk of the aorta splitting , especially if the aorta is dilated
Acquired heart disease
Develop during life rather than born with
May present for first tie in pregnancy
Are these symptoms abnormal
Important to make a diagnosis
What could Chest pain be due to
Myocardial infarction
Aortic dissection
Chest pain symptoms
Pain requiring opioids
Pain radiating to arm/shoulders/back/law
Sudden onset, tearing, exertions
Haemoptysis, SOB, syncope, abnormal neurology
Abnormal observations
Investigating chest pain
Bloods
ECG
Chest x ray
Further chest imaging
Us leg Doppler
Myocardial infarction
Aka heart attack
Blood flow via the coronary arteries to part of the heart muscle os impaired
Infarction - obstruction to the blood supply
Usually due to fatty deposits causing a thrombus or routing
A used by coronary artery disease
Can lead to cardiac arrest as heart cannot beat without oxygenation from coranory arteries
Incidence 1:100000
Aortic dissection
Splitting
Pregnancy horses increas fragility of tissues and increased cardiac input
AD 4 times more likely in pregnant vs non pregnant
More common in abnormal aorta
Symptoms - chest, back, neck,neck and abdominal pain, tearing front and back, sudden and transient pain
Treatment lower by and urgent surgery
Cardiomyopathy
Disease of the heart muscle
In dilated cardiomyopathy the muscle walls of the heart become stretched and thin so they cannot squeeze properly to pump blood around the body
In hypertonic cardiomyopathy, the heart muscle enlarge and the walls of the heart chambers thicken. The heart chambers are reduce in size so they cannnot hold much blood and the walls cannot relax properly and may stiffen . Also the flow of blood through heart may be obstructed
Breathlessness
Sudden onset
Orthopnoea
Associated with chest pain or syncope
Associated with tachycardia
RR>20, sats <94%
Causes of breathless
Anaemia
Heart disease
PE
Pneumothorax
Asthma
Neuromuscular disease
Covid
Delivery with heart failure
High risk of pulmonary oedema
Strict fluid balance
Invasive monitoring
Slow epidural
If severe will need delivery by CS
