Cardiac Disease Flashcards
Who III disease- 5 examples.
Mechanical valve Systemic right ventricle Fontan circulation Cyanotic heart disease Aortic dilatation (40-45 marfan’s, 45-50mm other)
Who IV cardiac disease- 5 examples
Pulmonary arterial hypertension LVEF <30% or NYHA 3-4 Previous ppcm, residual lv imp Severe aortic/mitral stenosis Aortic dilatation (>45mm marfans, >50mm other)
Who class II cardiac disease-
Repaired TOF Most arrhythmia Asd’s or vsd’s unrepaired Mild lvef HCM Bicuspid aorta <45mm Marfans, no dilatation Native or tissue valve
Who class I cardiac disease- 5 examples
Pulmonary stenosis Mitral valve prolapse PDA Ectopic beats Repaired simple lesions
Maternal mortality rate pulmonary hypertension?
10-25%
Lesions leading to PAH?
ASD/VSD (Eisenmenger’s syndrome) with PAH
chronic thromboembolic disease
lung disease (CF)
connective tissue disease (SLE)
Medications often required antenatally for PAH?
phosphodiesterase inhibitors (sildenafil), NO/prostanoid analogues, diuretics, thromboprophylaxis
PAH. Recommendations regarding
- mode of delivery,
- fluid balance in labour,
- uterotonics
- positioning
no evidence re LSCS vs. NVD
avoid hypovolaemia, systemic vasodilatation, maintain preload.
avoid syntocinon and regional analgesia causing vasodilatation
avoid supine positioning
High risk congenital heart lesions?
transposition
systemic RV
uni-ventricle defects
fontan circulation
Labour considerations patent ductus arterioles?
avoid hypotension i.e. epidural, spinal, syntocinon, PPH
Risk of VSD in offspring with maternal VSD?
10-15%
When might ASD/VSD deteriorate?
left to right shunt with PPH/reduced preload.
Effect on pregnancy of maternal congenital cyanotic disease?
cyanosis –> polycythemia –> VTE
hypoxia –> misc, SB, fetal growth restriction, PTB
pulmonary hypertension high mortality
Mitral stenosis. Effect of pregnancy on disease?
graded by velocity of blood flow across valve area.
velocity increases, therefore grading often worsens during pregnancy
increased risk of AF due to left atrial stretch.
Increased risk of clot formation left atria.
Management of mitral stenosis in labour?
fluid balance
avoid supine/sithotomy
treat pulmonary oedema
rate control (metoprolol)
Mortality and recovery of LV function in PPCM?
2% mortality
28% full recovery of LV function
if pregnant again with residual impairment
44% develop HF
Risks of thrombosis with LMWH and warfarin with mechanical valves?
5-7% LMWH (2-3% maternal death)
2-3% warfarin (0.9% maternal death)
When can warfarin cause embryopathy or fetopathy?
embryopathy = 6-12 weeks (not dose dependent)
fetopathy = 12-40 weeks (increased ICHH, INR in fetus can be 2-4x that of mother, dose dependent)
Inheritance of Marfan’s syndrome?
autosomal dominent
2-3/10,000 affected.
Change in cardiac output immediately PP?
rises 60-80%, rapid decline to pre labour values within 1 hour.
Uterotonics with mitral stenosis?
Oxytocin- IM only. Can cause pulmonary vasoconstriction, systemic vasodilation. Avoid IV.
ergometrine and carboprost- cause pulmonary and systemic vasoconstriction with may overload impaired ventricles
PR misoprostol is safe
Analgesia considerations mitral stenosis?
epidural- low dose to minimise haemodynamic instability.
Management of second stage with mitral stenosis?
passive second stage, operative vaginal delivery.
warfarin embryopathy features?
nasal hypoplasia
skeletal abnormalities
Cardiac conditions with mortality of 15% or more in pregnancy?
mechanical valve thrombosis any WHO class IV disease
