Cardiac Ds + Pregnancy

Question 1

Stenosis of peripheral arteries from:
• DM
• HLD
• HTN
• Tobacco smoking
Same causes as coronary disease

Answer 1

Peripheral artery disease

Question 2

• Pain in calves on exertion
• Relieved be rest
• Walking up or down hills
• Severe ds causes loss of: hair follicles, sweat glands, sebaceous glands
• Skin becomes smooth and shiny

Answer 2

PAD

Question 3

Pain is worse when walking down hills bs of leaning back

Answer 3

Spinal stenosis

Question 4

Best initial test PAD

Answer 4

Ankle-brachial index
• Ratio of BP in ankles to brachial arteries
• N equal or slightly greater in ankles bs of gravity
• If difference bw them is > 10%( ABI < 0.9)-> disease is present

Question 5

Most accurate test PAD. Not necessary unless revascularization will be done

Answer 5

Angiogram

Question 6

There is no routine screening for… since there is no mortality benefit to be obtained

Answer 6

PAD

Question 7

PAD Tx

Answer 7

Best initial tx
• Aspirin
• Smoking cessation
• Cilostazol
•Surgery or angioplasty if med tx not effective

Question 8

Single most effective medication PAD

Answer 8

Cilostazol

Question 9

In all major vascular disease control the following

Answer 9

• BP
• LDL < 100
• Diabetes

Question 10

Dissecting aorta. Best initial test( sudden onset chest pain, bw scapulae, HTN, smoking, BP 169/108

Answer 10

Chest X ray

Question 11

Most accurate aortic dissection

Answer 11

Angiogram

Question 12

• pain in bw the scapulae

* difference in BP bw the arms

Answer 12

Aortic dissection

Question 13

Most important step for aortic dissection

Answer 13

Control BP. This can be done with:
• BB
• nitroprusside

Question 14

Screening for aortic dissection

Answer 14

Men who ever smoked > 65 with US

Question 15

Peripartum cardiomyopathy

Answer 15

Most dangerous for pregnant pts 50-70% death

Question 16

Unknown why antibodies are made against the myocardium in some pregnant women

Answer 16

Peripartum cardiomyopathy

Question 17

LV dysfunction often reversible and short term. If LV dysfunction does not improve, then must undergo

Answer 17

Cardiac transplantation

Question 18

Tx for peripartum cardiomyopathy the same as for dilated cardiomyopathy

Answer 18

• ACEi/ARB
• BB
• Spironolactone
• Diuretics
• Digoxin
Repeat pregnancy with peripartum cardiomyopathy will kill 50-70 % of women

Question 19

Develops after delivery in most cases. ACEi/ARBs must be used

Answer 19

Peripartum cardiomyopathy

Question 20

• From right-to- left shunt from pulmonary HTN
• Develops in person with VSD with LtoR shunt that eventually develops pulmonary HTN
• When pulmonary HTN becomes very severe shunt reverses
• R to L shunting develops

Answer 20

Eisenmenger syndrome

Question 21

What is the worst cardiac disease in pregnant women

Answer 21

1) peripartum cardiomyopathy

2) Eisenmenger syndrome

Question 22

• MS will worsen in pregnancy

* But not as much as peripartum cardiomyopathy or Eisenmenger

Answer 22

Pregnancy increases plasma volume by 50%

Question 23

Large LtoR shunt( congenital heart disease)-> pulmonary HTN->

Answer 23

Reverse of the shunt Rto L shunt