Cardiology 2, Pregnancy

Question 1

Physiologic changes of pregnancy

Answer 1

Plasma volume increases (to 50% more than normal) small increase in red cell mass (relative anemia) Cardiac output increases by 30-50% PVR decreases. Heart rate increases. Pedal edema in 80% of HEALTHY pregnant women.

Question 2

Cardiac red herrings in pregnant women

Answer 2

increased jugular venous pressure
bounding carotid pulses,
ejection systolic murmur in the pulmonary <3/6
second heart sound is loud, commonly an S3 (diastolic filling) and maybe an S4.

Question 3

Worst heart problems to already have during pregnancy

Answer 3

stenotic lesions because of decreased PVR and increased output.aortic stenosis is much less well tolerated than mitral regurgitation. Pts with NYHA functional class II or IV have a maternal mortality of nearly 7%

Question 4

Cardiac reasons to NEVER get pregnant

Answer 4

Marfan syndrome with dilated aortic root
Eisenmenger syndrome (maternal 50% mort, fetal nearly 100%)
primary pulmonary hypertension
severe aortic stenosis or mitral stenosis
symptomatic dilated cardiomyopathy

Question 5

Cardiac reasons to consider not getting pregnant

Answer 5

atrial septal defect (DVTs can lead to paradoxic embolus)

coarctations (risk of dissection and rupture.)

Question 6

If someone with a cardiac contraindication to pregnancy DOES get pregnant, what should she do?

Answer 6

minimal activity, refuce sodium, minimize anemia. Maybe bedrest. Operative intervention may be necessary, delay til after the 1st trimester due to increased 1st trimester fetal loss.

Question 7

Cardiac drugs safe in pregnancy

Answer 7

digoxin, quinidine, procainimide, beta blockers and verapamil.
Beta blockers may cause fetal growth retardation, neonatal bradycardia and hypoglycemia.

Question 8

Drugs to be avoided in pregnancy

Answer 8

ACE-I (fetal renal dysgenesis)
phenytoin (hydantoin syndrome, teratogenic)
warfarin (teratogen, abortogen)
tetracycline

Question 9

Hemodynamics of delivery

Answer 9

each contraction increased circulation by 500ml
cardiac output increased with advancing labor
oxygen consumption increses 3-fold
High risk patients might need Swan-ganz cathetere
deliver in the left lateral position.
Vaginal is safer than cesaean

Question 10

What are the causes of hypertension during pregnancy and what are the parameters?

Answer 10

chronic hypertension (bp > 140/80 before preg)
transient hypertension (developed during)
preeclampsia ( started >=20 wks)
combinations that raise systolic blood pressure > 30mm or diastolic 15mm or diastolic > 90mm

Question 11

Drugs to control prenatal hypertension

Answer 11

methyldopa, beta blockers (but may lead to growth retardation and fetal brady) Hydralazine may be added byt may lead to fetal thrombocytopenia.
Diuretics may be helpful if they were prescribed prior to pregnancy but are not typically added.