Cardiac diseases Flashcards

1
Q

Why does pregnancy impose great effort on the heart?

A

due to increased
- cardiac output
- stroke volume
- heart rate

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2
Q

What are the types of heart disease?

A

Acquired
- Rheumatic heart disease: mitral stenosis (90%)
- coronary heart disease

Congenital
- atrial septal defect
- ventricular septal defect
- tetralogy of fallot

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3
Q

What should be done is preconception counseling in case of suspected heart disease?

A
  • assessment done by obstetrician & cardiologist
  • assess ejection fraction & cardiac function
  • optimization of medication
  • check need for surgical correction
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4
Q

What are the risks of heart disease in pregnancy?

A

on MOTHER
- increased mortality
- frequent admissions
- interventions

on FETUS
- congenital heart disease
- preterm labour
- FGR
- effects of drugs

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5
Q

What are the high risk heart conditions that increase the rate of maternal mortality?

A

1- pulmonary hypertension
2- ischemic heart disease
3- Eisenmenger’s syndrome
4- Marfan syndrome with aortic root >40mm diameter
5- peripartum cardiomyopathy
6- prosthetic heart valves (metal)

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6
Q

How does a patient present in case of heart pathology in pregnancy?

A
  • breathlessness (progressive dyspnea)
  • decreased exercise tolerance
  • fatiguability
  • palpitation
  • peripheral edema
  • hemoptysis
  • chest pain
  • syncope
  • nocturnal cough
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7
Q

What are the markers for cardiac events?

A

1- prior episode of heart failure, arrhythmia, stroke
2- NYHA > class 2 or cyanosis
3- left heart obstruction
4- reduced left ventricular function (EF < 40%)

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8
Q

How should a mother with known heart disease be managed during pregnancy?

A

1- frequent ANC visits to check for symptoms of heart failure
2- routine physical: PR, BP, JVP, heart sounds, ankle & sacral edema, basal crepitations
3- reduce physical activity
4- LMWH in: pulmonary hypertension, prosthetic heart valves, & atrial fibrillation
5- serial maternal ECHO: at booking & at 28 weeks
6- in women with congenital heart disease -> fetal cardiac ultrasound

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9
Q

What anticoagulants should be used in case of prosthetic heart valves?

A
  • First trimester -> LMWH
  • Second trimester -> Warfarin
  • from 36 weeks -> LMWH
  • Postpartum -> heparin & warfarin
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10
Q

How should a patient with cardiac disease deliver their baby?

A

1- aim for vaginal delivery with spontaneous onset
2- administer oxygen & epidural analgesia
3- give prophylactic antibiotic for structural heart defects to guard against subacute bacterial endocarditis
4- elective instrumental delivery to shorten 2nd stage of labour
5- in 3rd stage of labour give oxytocin with low infusion rate
avoid ergometrine

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11
Q

When is C section indicated in case of heart disease & what are the risks associated with it?

A

recommended for:
- dilated aortic root >4cm or aortic aneurysm
- acute severe congestive failure
- recent myocardial infarction
- need for emergency valve replacement immediately after delivery

risk of hemorrhage, infection, & thromboembolism

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12
Q

What is the cause of postpartum intravascular overload?

A

sudden emptying of uterine venous sinuses after placental delivery

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13
Q

What are the risk factors for heart failure in pregnancy?

A

OB
- multiple pregnancy
- hemorrhage
- tocolytics
- corticosteroids
- pain related stress

MEDICAL
- anemia
- hypertension
- respiratory infections
- obesity
- arrhythmias
- fluid overload

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14
Q

What is the cause of ischemic heart disease in pregnancy?

A

Coronary artery dissection postpartum rather than atherosclerosis in women above 40 years
- peaks in 3rd trimester parous ladies

manage by percutaneous transluminal coronary angioplasty (PTCA)

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15
Q

What is the cause of mitral stenosis and how is it treated?

A
  • acquired rheumatic
  • 40% worsens during pregnancy at 30 weeks

Treated by: bed rest, diuretics, oxygen, beta blockers
Definitive: Balloon mitral valvotomy (post partum)

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16
Q

What is the cause of aortic stenosis and how is it treated?

A
  • congenital

treated by: bed rest + medical treatment to reduce heart rate
Balloon or surgical aortic valvotomy can be done

17
Q

What are the effects of Marfan syndrome on pregnancy?

A
  • mitral valve prolapse, aortic root regurgitation, aortic root dilatation, aortic dissection & rupture -> 50% mortality rate
  • early pregnancy loss, preterm labour, cervical weakness, uterine inversion, & postpartum hemorrhage

ECHO should be done to determine size of aortic root (esp if > 4cm from the beginning)

18
Q

How is pulmonary hypertension managed during pregnancy?

A

1- endothelin blockers (bosentan)
2- phosphodiesterase inhibitors (sildenafil)
3- in women who wish to continue their pregnancy: targeted pulmonary vascular therapy ]

median survival: <3years from diagnosis
mortality rate: 30-50%

19
Q

What are the symptoms of pulmonary hypertension?

A

increased pulmonary vascular resistance
- fatigue
- breathlessness
- syncope