Cardiac Diseases in Pregnancy

Question 1

Hemodynamic & Cardiovascular changes begin _____ in pregnancy, _______ during the late _____ trimester & remain ________ until delivery.

Answer 1

early, peak, 2nd, constant

Question 2

1st Trimester

Answer 2

0 - 13 weeks

Question 3

2nd Trimester

Answer 3

14 - 26 weeks

Question 4

3rd Trimester

Answer 4

27 - 40 weeks

Question 5

Hemodynamic & Cardiovascular changes affect?

Answer 5

• Cardiac output
• Blood pressure
• Systemic vascular resistance
• Heart rate
• Blood volume

Question 6

Define Systemic Vascular Resistance

Answer 6

The resistance that must be overcome to push blood through the systemic circulation & create flow.

Question 7

Change in systemic vascular resistance in pregnancy

(either increases or decreases)

Answer 7

• Drops by approx. 35 - 40% from around 5 wks gestation and nadirs (low point) in the mid-2nd trimester.

Question 8

Drop in systemic vascular resistance is due to?

Answer 8

Systemic vasodilation due to pregnancy

Question 9

Define Cardiac Output (CO)

Answer 9

The volume of blood that is pumped by the heart every minute.

CO = stroke volume (SV) x heart rate (HR)

Question 10

Cardiac output equation

Answer 10

CO = stroke volume (SV) x heart rate (HR)

Question 11

Change in cardiac output (CO) in pregnancy

(either increases or decreases)

Answer 11

It begins to rise in the 2nd trimester & peaks during the 3rd trimester.

Question 12

Change in heart rate (HR) in pregnancy

(either increases or decreases)

Answer 12

HR rises throughout gestation & peaks in late 3rd trimester at average of 16bpm above non-pregnant valves.

Question 13

Change in blood pressure (BP) in pregnancy

(either increases or decreases)

Answer 13

Falls gradually around 12 wks gestation & reaches nadir (low point) at 18 wks gestation
THEN
gradually rises to pre-pregnant levels at term (>37 wks)

Question 14

Normal pregnancy is characterized by:

Answer 14

• an increase in cardiac output CO
• reduction in systemic vascular resistance
• minimal change in mean blood pressure

Question 15

Change in blood volume in pregnancy

(either increases or decreases)

Answer 15

Increases due to increase in plasma volume & red blood cell mass.

Question 16

There is an increase in total blood volume due to?

Answer 16

increase plasma volume & increase red cell mass

Question 17

Change in plasma volume in pregnancy (blood volume)

Answer 17

• Increases by 10 - 15% at 6 - 12 wks gestation
• Expands rapidly until 30 - 34 wks gestation, then plateaus.

Question 18

Change in red blood cell mass in pregnancy (blood volume)

Answer 18

• begins to increase at 8 - 10 wks gestation
• steadily rises by 15 - 20% above non-pregnant levels by the end of the pregnancy.
• increases small relative to plasma volume

Question 19

What is physiological/dilutional anemia in pregnancy?

Answer 19

This is when the increase in RBC mass is smaller than the increase in plasma volume, causing a mild decrease in hemoglobin concentration.

Question 20

What are 3 functions or uses of risk assessment tools in pregnancy?

Answer 20

1. Used to evaluate risk of cardiac event during pregnancy in women with heart conditions.
2. Helps determine frequency of clinical re-evaluation throughout the pregnancy.
3. Establishes plans for labour, delivery & postpartum.