Cardiac disease in pregnancy Flashcards
Explain the aetiology of cardiac disease in pregnancy.
Congenital heart disease – PDA, atrial septal defect, ventricular septal defect, Tetralogy of Fallot, Coarctation of the aorta
Acquired heart disease – ischaemic heart disease and valve disease
Cardiomyopathies – peripartum cardiac myopathy: CMP with heart failure, occurring in the 4 weeks before term date and persisting 5 months after delivery.
What are the risk factors for cardiac disease in pregnancy?
FHx, obesity, age, HTN, smoking
Summarise the epidemiology of cardiac disease in pregnancy.
Increasing prevalence with higer maternal age and CVD risk in population.
Recognise the presenting symptoms of cardiac disease in pregnancy.
SOB
Palpitations
Orthopnoea
Paroxysmal nocturnal dyspnea (PND)
Low exercise tolerance
Chest pain.
Recognise the signs of cardiac disease in pregnancy on physical examination.
General: pulse, BP, JVP, odema, cyanosis
Chest: heart sounds, murmurs (ESM common in pregnancy), basal crepitations
Abdomen: fundal height (IUGR)
Identify appropriate investigations for cardiac disease in pregnancy and interpret the results.
Bloods: FBC, U+Es, LFTs
Cardiac: Echo, ECG
Fetus: serial USS for growth, cardiac anomaly if congenital
Generate a management plan for cardiac disease in pregnancy.
- General: obstetrics/cardiology care during pregnancy
Preconceptual: assess cardiac status, address risk. Monitor clotting and fetus
Delivery: consider optimum mode and timing of delivery, consult with anaesthetist, fluid management.
Post partum surveillance (haemodynamic change)
Identify the possible complications of cardiac disease in pregnancy and its management.
Maternal: progression of disease, VTE, death.
Fetal: congenital heart disease, intrauterine growth restriction, teratogenic drugs.
Marfans syndrome patients with aortic root >4.5cm advised against pregnancy
Summarise the prognosis for patients with cardiac disease in pregnancy.
High maternal death (LVEF<40% > 50% death).
