CARDIAC DISEASE IN PREGNANCY

Question 1

What are cardiovascular /haemodynamic changes of pregnancy?

Answer 1

• Increased blood volume
• Increased HR (10-20bpm higher)
• Increased cardiac output (50%)
• Reduced total peripheral resistance (40-70%)
• Peak effects late in 2nd trimester or early 3rd trimester
• Aorta: loss of normal configuration of elastic fibres, fragmentation of reticulum fibres; diminished acid mucopolysaccharides; oestrogen inhibits collagen and elastin deposition in aorta and progesterone accelerates deposition of non-collagenous protein in aorta

Question 2

What is the NYHA classification of heart failure?

Answer 2

1 = no limitation of physical activity. Ordinary physical activity does not cause symptoms 
2 = slight limitation of physical activity. Comfortable at rest. Ordinary physical activity → fatigue, palpitations, SOB 
3 = marked limitation of physical activity. Comfortable at rest. Less than ordinary activity → fatigue, palpitations, SOB 
4 = unable to carry on physical activity without discomfort. Symptoms at rest. If any physical activity discomfort increases.