cardiology

Question 1

parameters
a) increase
b) decrease
c) remain same

Answer 1

a) C O ( stroke vol x HR) , femoral venous pressure, PR
b) peripheral resistance, BP( SYS < DIA)
c) JVP, antecubital venous pressure, LV ejection fraction

Question 2

supine hypotension syndrome
best position?

Answer 2

in pregn women
in late 3rd TRIMESTER
due to compression of IVC -> RED. VENOUSRETURN -> RED. C O
mother: hypotension fetal : distress
best position left lat > right lat

Question 3

normal changes during pregn
a) apex beat
b) ecg
c) xray
d) heart sounds

Answer 3

a) left 4th IC 2.5 cm lat to midclav line
b) left axis deviation (upto 15 is normal), non specific st changes, st depression
c) apparent cardiomegaly, straightening of the left heart border
d) S1- loud and prominent, S2- normal, S3- easily heard

Question 4

physiological murmurs of the heart during pregn

Answer 4

i- ejection systolic murmur ( < grade 3/6)
ii- continuous mammary murmur
iii- diastolic murmur - r/o heart disease before labelling as physiological murmur

Question 5

signs of heart disease in pregn

Answer 5

i- cyanosis, clubbing, engorged neck veins
ii- xray marked cardiomegaly
iii- heart sounds- S2: loud and prominent split, S4: audible
iv- mumur: ESM >3/6, Diastolic murmur

Question 6

m/c in pregn
a) cardiac disease 1st, 2nd
b) lesion
c) congential
i -heart disease and congential valvular disease
d)

Question 7

m/c in pregn
a) cardiac disease 1st, 2nd
b) lesion
c) congential
i - heart disease
ii- valvular disease during pregn
iii- congential cyanotic disease during pregn
d) highest risk of maternal mortality
e) cause and time of death

Answer 7

a) RHD, 2nd - ASD
b) MS
c) i- ASD
ii - MVP
iii- TOF
d) eisenmerger syndrome
e) RVF with cardiogenic shock
time - at delivery / within 1 week of delivery

Question 8

absolute c/i for pregn - explain

Answer 8

eisenmerger syndrome - 2ndary pulm. htn
underlying cardiac effects - ASD, VSD, PDA

Question 9

heart diseases which are c/i in pregn

Answer 9

eisenmerger syndrome
marfan syndrom with aortic root dilatation > 4 cms
severe aortic - dilation , coarctation
severe left heart obstrution - ef <30%
h/o peripartum cardiomyopathy with residual dysfunction
fanton’s surgery done with residual effect
nyha class III ( dyspnea < n activity), IV (dyspnea @ rest)

Question 10

management of cardiac disease

Answer 10

NYHA I / II - routine ANC, review at 28-30 weeks,delivery at term
NYHA III / IV -
1st tri - MTP
2nd and 3 rd tim - admit and rx for cardiac failure , pulm edema - hospitalisation and delivery at term

Question 11

cardiac surgery in pregn
a) when is done
b) procedure
c) conditions

Answer 11

a) T2
b) ballon val vulo plasty
c)
MS + pulm edema ( recurrent / hard to deal with)
Cardiac failure not responding to medical rx
NYHA class III or IV
Asymptomatic women with mitral valve area < 1.5 cm
life threatening conditions

Question 12

peripartum cardiomyopathy
a) define
b) pre requistes
c) echo findings
d) coexisiting factors
e) treatment

Answer 12

a) cardiac failure > 35 weeks GA or postpartum uptil 5months
b) absence of 2 things
i- identificiable cause of cardiac failure
ii- recognisible heart disease prior to last month of pregnancy
c) EF < 45%, LV dimensions decreased
d) PIH - SFLT levels high
etiological agwnt : vasoinhibin
e) BROMMOCRIPTINE