Cardiac Disease in Pregnancy Flashcards

1
Q

How commonly is cardiac disease in pregnancy a cause of maternal death?

A

It is the main cause of indirect maternal death

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2
Q

How is the prevalence of cardiac disease in pregnancy changing?

A

Increasing

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3
Q

What is thought to be causing the increase of cardiac disease in pregnancy?

A
  • More people surviving congenital cardiac disease and having children
  • More acquired heart disease
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4
Q

Why does pregnancy have an adverse effect on pre-existing cardiac disease?

A

It puts strain on the cardiovascular system

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5
Q

What is one change in pregnancy that can worsen pre-existing cardiac disease?

A

Rise in cardiac output

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6
Q

What are some symptoms of cardiac disease that are also symptoms of normal pregnancy?

A
  • Breathlessness
  • Palpitations
  • Syncope
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7
Q

What are some cardiovascular signs that are mimicked in pregnancy?

A
  • Bounding pulse

- Systolic murmur

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8
Q

What is the result of cardiac disease signs and symptoms being present in some normal pregnancies?

A

It can be hard to diagnose a new or deteriorating cardiac disease

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9
Q

What can women with pre-existing cardiac disease in pregnancy be at higher risk of?

A
  • Congestive cardiac failure
  • Worsening hypoxia
  • Arrhythmias and sudden death
  • Bacterial endocarditis
  • VTE
  • Angina and MI
  • Aortic dissection
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10
Q

How can cardiac disease affect pregnancy?

A
  • Pre-eclampsia
  • IUGR
  • Preterm birth
  • Fetal loss
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11
Q

What are some examples of medications that are taken in cardiac disease that may need review in pregnancy?

A
  • ACE inhibitors

- Warfarin

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12
Q

What is the risk of congenital heart disease being present in the baby of a woman with congenital heart disease?

A

Up to 5%

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13
Q

How should women with cardiac disease in pregnancy be managed?

A

In an MDT

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14
Q

Who should be involved in the MDT management of pregnant women with cardiac disease?

A
  • Obstetricians
  • Cardiologists
  • Obstetric anaesthetists
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15
Q

When should the MDT management of pregnant women with cardiac disease begin?

A

Ideally in the preconception phase

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16
Q

When may pregnancy not be advisable in women with cardiac disease?

A

If they have poor cardiac functional status

17
Q

Give an example of a cardiac condition with a poor prognosis in pregnancy?

A

Eisenmenger’s syndrome

18
Q

What is the maternal death rate in Eisenmengers syndrome?

A

40-50%

19
Q

What may antenatal care in women with cardiac disease involve?

A
  • Minimisation of stressors
  • Alteration of medications
  • Anticoagulation if required
  • Fetal surveillance
20
Q

Give 2 examples of stressors that should be reduced in pregnant women with cardiac disease

A
  • Anaemia

- Infection

21
Q

What fetal surviellance is done in pregnant women with cardiac disease?

A
  • Serial growth scans
  • Doppler measurements
  • Screening for cardiac defects
22
Q

What measures should be taken in labour in cardiac disease?

A
  • Minimise pain

- Ensure fluid balance is maintained

23
Q

What is the most risky time for pregnant women with cardiac disease?

A

Post-partum period

24
Q

What is the result of the post-partum period being the most risky time for women with cardiac disease?

A

Careful surveillance is required