Cardiac Disease in Preg Flashcards
Who needs prophylaxis for endocarditis?
Vaginal delivery +
- Un-repaired cyanotic cardiac disease (ASD/VSD uncorrected tetralogy of fallot)
- Prosthetic heart valves
- Previous endocarditis
What is prophylaxis for endocarditis in pregnancy?
Amoxicillin 2 g PO OR
Ampicillin 2 g IV
30-60 mins before procedure
NYHA Classification of Heart Disease
Class I = No limitations to activity
Class II = Mild symptoms w/ regular activity
Class III = Marked symptoms on regular activity
Class IV = Symptomatic at rest
Most common rheumatic heart lesion?
Mitral stenosis
Fixed cardiac output due to narrowed mitral valve
Prevents blood from leaving left atrium causing it to back up into lungs
Why do patient’s with Mitral Stenosis decompensate in pregnancy?
Normal physiologic changes in pregnancy = increased blood volume (50%), increased HR
Tachycardia decreases diastolic filling time which worsens situation
25% of these patients present in heart failure for the FIRST TIME DURING PREGNANCY
Treatment for Mitral Stenosis during pregnancy?
Beta blocker to decrease heart rate (increase diastolic filling time)
General Principles for Cardiac Disease in pregnancy?
AVOID fluid overload, Tele in labor, Strict I/Os
NSVD preferred (with exception of Marfans syndrome with dilated aortic root, they should have cesarean)
Avoid valsalva, allow patient to labor down (let uterus do the work)
Shorten second stage (operative vaginal delivery)
Reverse trendelenberg, avoid raising legs over heart
Third stage most risky with fluid shifts!
In what conditions is pregnancy contraindicated?
Pulmonary Hypertension
Severe Cardiomyopathy, EF < 30%
Severe aortic stenosis, bicuspid aortic valve with dilation
Marfan’s syndrome with dilated aortic root (> 4.5 cm)
NYHA Class 4 cardiac disease
Work up for cardiac symptoms in pregnancy?
BNP > 100 suggests diagnosis of HF, ECHO
Troponin + EKG to rule out ACS
CXR to evaluate for pulmonary etiology
Holter monitor for arrhytmias
CT if concern for PE or aortic dissection
*Consider exercise stress test w/ pre-conception counseling
Management of cardiac arrest?
- Prioritize bag mask ventilation w/ 100% and EARLY intubation w/ small ET tube (6-7 mm)
- Aortocaval compression by uterus larger than 20 wks. Manual left uterine displacement early in resuscitation
- Chest compression 100 bpm (30 compressions: 2 breaths)
- Consider defibrillation
- Epinephrine is the vasopressor of choice and should be administered by IV and IO access above the diaphragm
- Start C/S at 4 minutes, delivery by 5
- Consider cardiopulmonary bypass or ECMO
Risk factors for cardiac disease in pregnancy?
Black race
Age > 40
Hypertension
Diabetes
Obesity
Define peripartum cardiomyopathy?
Pregnant or 5 months PP
EF < 45%
Treatment of STEMI?
Oxygen
Nirates
ASA
IV unfractionated heparin
B blocker
Treatment of peripartum cardiomyopathy?
Diuresis
BBlocker (metroprolol)
ACE/ARB POSTPARTUM
Anticoagulation
Treat arrythmias