Cardiac disease in pregnancy

Question 1

What is most likely to cause death?

Answer 1

MS

• APO
• Sudden death if get hypovolaemic
• should control HR in labour

Question 2

VSD and ASD?

Answer 2

usually ok unless pulmonary hypertension

Question 3

SVT treatment in preg?

Answer 3

The same, including shocking if neede

Question 4

How many marfans in preg get a complication?

Answer 4

15%

best outcomes if root under 40 mm

Question 5

Pulmonary hypertension?

Answer 5

Can’t get pregnant
Sudden death die to hypotension after blood loss, prolonged valsalva or regional anaesthesia

VAGINAL delivery preferred as less stressful on vagina

Question 6

Sinus tachy normal?

Answer 6

Normal to 110

Question 7

What if dilated CM and want to get preg again?

Answer 7

If LV returns to normal, that is fine

Question 8

How to manage dilated CM in preg?

Answer 8

?need AICD

• no warf; use clex
• no ACE
• dig, beta blockers not atenolol, diuretics ok

Question 9

Indications for abx at delivery?

Answer 9

NOT normal vaginal delivery for SBE proph

Question 10

Should you test women with DVT in preg for thrombophilia?

Answer 10

If first then no

Question 11

stroke vol in preg

Answer 11

increase in T1 and T2

decrease in T3

Question 12

When is pregnancy contraindicated?

Answer 12

PAH any cause
LVEF under 30 or NYHA 3-4
prev post partum CM with residual deficit
severe MS
severe symptomatic AS
Marfan >45mm
>50mm with bicusp aortic 
native severe coarctation

Note cyanotic unrepaired not on the super high list
Note HCM not on super high list

Question 13

How do you manage a mechanical mitral valve?

Answer 13

clexane for 6-14 weeks

warfarin until UFH at delivery

Question 14

Tx of choice for ventricular arrhythmias?

Answer 14

Lidocaine