Cardiac Disease - General Flashcards
WHO maternal risk classification I
- No increased risk of mortality or no/mild increase in morbidity
Uncomplicated small or mild PS, PDA, MVP
Successful repaired simple lesions - ASD, VSD, PDA, Anomalous pulmonary venous drainage
Atrial or ventricular ectopic beats
WHO maternal risk classification II
- Small increased risk of mortality or moderate increase in morbidity
Unoperated ASD or VSD
Repaired ToF
Most arrhythmias
WHO maternal risk classification II-III
-Risk is depending on the individual
Mild left ventricular impairment
Hypertrophic cardio myopathy
Native or tissue valvular heart disease not considered WHO I or IV
Marfan syndrome without aortic dilatation
Aorta greater than 45 mm in aortic disease associated with bicuspid aortic valve
Repaired Coarctation of the aorta
WHO maternal risk classification III
- Significantly increased risk of mortality or severe increase in morbidity
Mechanical valve
Systemic right ventricule Fontan circulation
cyanotic heart disease unrepaired
Other complex congenital heart disease
Aortic dilatation 40 to 45 mm in Marfan syndrome
Aortic dilatation 45 to 50 mm in aortic disease associated with bicuspid aortic valve
WHO maternal risk classification IV
- Extremely high risk of mortality or severe increase in morbidity
Pulmonary arterial hypertension of any cause
Severe systemic ventricular dysfunction Determined by Lefant your cooler ejection fraction less than 30% and New York heart classification three through four
Previous peripartum cardiomyopathy with residual impairment of left ventricular function
Severe mitral stenosis
Severe symptomatic aortic stenosis
Marfan syndrome with aortic dilatation greater than 45 mm
Aortic dilatation grade and 50 mm in aortic disease associated with bicuspid aortic valve
Severe coarctation of the aorta
Cardiac conditions for which antibiotic prophylaxis for bacterial endocarditis is reasonable
Unrepaired cyanotic congestive heart disease including palliative shunts and conduits
Completely repaired congenital heart disease with prosthetic material or conduits
In completely repaired congenital heart disease with residual defects at or near the site of prosthetic patch or device
These maternal cardiac defects are considered group 1 and have less than 1% mortality risk with pregnancy
Atrial septal defect Ventricular septal defect Patent ductus arteriosus Mitral stenosis with NYHA I and II Pulmonary/tricuspid valve disease Tetralogy of fallot - corrected Bioprosthetic valve
These maternal cardiac defects are considered group 2A and have 5 to 15% mortality risk with pregnancy
Mitral Stenosis with NYHA class III and IV
Aortic stenosis
Coarctation of the aorta without valvular involvement
Uncorrected Tetralogy of fallot
Previous myocardial infarction
Marfan syndrome with normal aorta
These maternal cardiac defects are considered group 2B and have a 5-15% mortality risk with pregnancy
Mitral stenosis with Atrial fibrillation
Artificial valve
These maternal cardiac defects are considered group 3 and have 25-50% mortality risk with pregnancy
Pulmonary hypertension
Primary Eisenmenger syndrome
Coarctation of aorta with Valvular involvement
Marfan syndrome with aortic involvement
Peripartum cardiomyopathy with persistent left ventricular dysfunction
What are the risks of fetal cardiac abnormality by maternal lesions
Tetralogy of fallot - 2-4% Aortic coarctation - 4 to 14% ASD 4 to 11% VSD 6 to 15% Pulmonary stenosis 5 to 6% Aortic stenosis 8 to 17% persistent ductus arteriosus 4.1% Marfan syndrome 50% 22Q 11 deletion syndrome 50%
What are the components and scoring for the CARPREG Risk Score
For each CARPREG predictor that is present a point is assigned:
Zero predictor equals 5% risk of cardiac event in Pregnancy
One predictor equals 27% risk of cardiac event in Pregnancy
Greater than one predictor equals 75% risk of cardiac event in pregnancy
Predictors are:
- New York heart Association classification greater than two
- Cyanosis less than 90% saturation on room air
- Prior cardiovascular event
- Systolic ventricular ejection fraction less than 40%
- Left heart obstruction
New York heart Association functional classification system class one
No limitations of physical activity.
Ordinary physical activity does not precipitate cardiovascular symptoms such as dyspnea angina, fatigue or palpitations
New York heart Association functional classification system class two
Slight limitation of physical activity.
Ordinary physical activity will precipitate cardiovascular symptoms
Patients are comfortable at rest
New York heart Association functional classification system class III
Less than ordinary physical activity precipitate symptoms that markedly limit activity
Patients are comfortable at rest
