cardiac diseases Flashcards
1
Q
risk to baby if mother/father has congenital heart disease
A
Mother: 6 %
Father: 2 %
Sibling: 15 -30 %
Both:
2
Q
congenital cardiac anomaly, classification
A
- -
3
Q
Natural law of transmission of cardiac disease
A
- high risk anomalies lowest risk of transmission <5 %
- low risk highest risk of transmission: 25 - 40 %
4
Q
Low risk cardiac congenital anamalies
A
1 - Small left to right shunt
- ASD
- VSD
- PDA
2 - Coarctation of aorta with raised BP, more with turner syndrome
3 - Tetraloy of Fallot
5
Q
Pregnancy with Small left to right shunt (ASD, VSD & PDA)
A
- Due to decrease peripheral vascular resistance, in pregnancy shunting is reduced.
- In absence of pulmonary HTN - pregnancy, labour, delivery well tolerated
- ASD: atrial arrhythmia & paradoxical emboli so low threshold for heparin
- Acute blood loss & acute vasodilation due to regional anesthesia can affect shunt degree & direction acutely, reducing left ventricular output
6
Q
Pregnancy with Coarctation of aorta
A
- with raised BP, more with turner syndrome
- 6 - 8% of congenital anomalies
- Well tolerated pregnancy with well repaired coarctation of aorta
- Assess cardiac status before conception to manage complications like HTN, recoarctation, aneurysm at site of repair & associated bicuspid aortic valve.
- Pregnancy associated complication aortic dissection & rupture & HTN
- Poorly controlled HTN : Maternal complication (preeclampsia, HTN crises, rupture of intacranisal aneurysm) fetal complications:FGR, Abrution, premature delivery)
7
Q
Pregnancy with Tetraloy of Fallot
A
- the most common form of cyanotic congenital heart disease
- Pregnancy with repaired ToF well tolerated
- Arrhythmia & right ventricular failure specially in (residual shunt, RT ventricular outflow obstruction & pulmonary HTN)
- Many pulm regurgitation symptomatic, occasional need diuretic admission & bed rest
8
Q
Moderate risk cardiac lesions
A
- Transposition of great arteries (TGA)
- Cyanotic heart d/s without pulmonary HTN, if pulmonary HTN TOP under clause A
- Fontan procedure
9
Q
High risk cardiac lesions
A
- Marfans syndrome
- Pulmonary vascular disease
10
Q
TGA and pregnancy
A
- Post- repair:rt ventricle becomes systemic one, long term complications: systemic rt ventricular failure, tricuspid regurgitation, sinus node dysfunction, arrhythmia & baffle obstruction (venous pathway obstruction)
- pregnancy well tolerated following uncomplicated repair, rt ventricular dysfunction &/or atrial arrhythmia, may occur
- If long term complications, pregnancy poorly tolerated, increased risk of cardiac complications
11
Q
Cyanotic heart d/s without Pulmonary HTN
A
- Caused by uncorrected transposition of great arteries, truncus arteiorsis, uncorrected ToF with , tricuspid atresia & Ebstein anomaly’s with ASD
- During pregnancy fall in systemic vascular resistance & rise in cardiac output exacerbates any right to left shunting, worsening preexisting cyanosis & hypoxia.
- Maternal complications: haemorrhage, paradoxical embolism & heart failure
- effects on fetus marked: increase miscarriage, 30-50 % premature delivery & LBW
- degree of maternal hypoxemia : most important predictor of neonatal outcome
- Admission for bed rest & oxygen therapy effective for mother & fetus.
12
Q
Fontan procedure
A
- definitive palliative procedure for cyanotic heart d/s, characterized by single functional ventricle
- Atrial separation divides systemic & pulmonary circulations & with construction of aortopulmonary connections blood enters pulmonary circulation without pulsatile ventricle.
- Main concern regarding pregnancy is ability augment maintain & adjust cardiac output & heart rate.
- Maternal risks : low in NHYA 1-2, provided ventricular function is good,
13
Q
Marfans syndrome
A
- inherited of connective tissue
- autosomal dominant
- thoracic aortic aneurysm leading to aortic dissection, rupture or both increased in pregnancy
- Aortic root <4 cm, overall maternal mortality 1 % during pregnancy, increases 25 % when >4 cm
- pregnancy should be postponed until aortic arch replacement & in unplanned TOP
- Aortic root diameter monitor by serial echo & if aortic root dilatation occurs, prophylactic beta blockade is advised & HTN treated aggressively.
- systolic HTN : most deaths in aortic HTN
14
Q
Pulmonary vascular disease
A
- pregnancy poorly tolerated, worsening cyanosis & hypoxia, arrhythmia, heart failure & death
- majority of complications at term & first week postpartum
- maternal mortality depends on underlying cause: 36 % in Eisenmenger syndrome, 30 % in primary pulmonary HTN & 56 % in secondary pulmonary HTN.
15
Q
Acquired heart diseases
A
- peripartum Cardiomyopathy
- MI
- valvular / valve replacement during pregnancy
