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CARE OF MOTHER, CHILD, AND AT RISK (ACUTE AND CHRONIC) > CARDIOVASCULAR DISORDERS > Flashcards

CARDIOVASCULAR DISORDERS Flashcards

1
Q

cardio disorders complicates only approximately ___% of all
pregnancies

A

1%

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2
Q

cardio probs that commonly causes difficulty in pregnanc:

A
  • valvular damage by rheumatic fever or kawasaki
  • congenital anomalies (ASD or uncorrected coarction of aorta)
  • increasing age of women
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3
Q

Blood volume & cardiac output increase approximately ___%

A

30-50%

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4
Q

The danger of pregnancy in a woman with cardiac disease occurs due to increase in ___. The most dangerous time for a woman is in
weeks ___, just after the blood volume peaks

A

circulatory volume
28-32

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5
Q

true or false - Functional or transient murmurs &
heart palpitations (sudden exertion)
present & normal

A

true

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6
Q

congenital heart defects - left to right

A

atrial septal defect
ventricular septal defect
patent ductus arteriosus

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7
Q

congenital heart defects - right to left shunt

A

TOF
eisenmenger syndrome

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8
Q

enables blood flow
between the left &
right atria via the
interatrial septum

A

atrial septal defect

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9
Q

Pregnancy is well
tolerated w/
uncomplicated ___

A

ASD

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10
Q

true or false - in ASD, Pulmonary HPN occasionally develops

A

true

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11
Q

For a secundum defect,
___ can be performed during
pregnancy

A

catheter device closure

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12
Q

management for ASD

A

use compression stockings
avoid supine position
early ambulation after delivery

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13
Q

happens when an
opening between
the two bottom
chambers
(ventricles) of the
heart is present

A

ventricular septal defect

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14
Q
  • More common than ASD
  • Detected & corrected before
    childbearing age
A

VSD

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15
Q

women w/ VSD who become pregnant are asymptomatic, but ___ or symptoms of ___ occur occasionally

A

fatigue
pulmonary congestion

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16
Q

Corrected VSDs have a good prognosis during pregnancy, when LV function is preserved.
Although, ___ may occur

A

pre-eclampsia

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17
Q

VSD - * Pregnancy occasionally
precipitates ___ or a
dysrhythmia

A

heart failure

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18
Q

what is common is unrepaired VSD

A

bacterial endocarditis

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19
Q

what is recommended to avoid bacterial endocarditis

A

antibacterial prophylaxis

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20
Q

caused by the failure to close of the ductus arteriosus after birth

A

patent ductus arteriosus

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21
Q

true or false - PDA - Small defect may be well tolerated during pregnancy unless complicated by pulmonary
HPN

A

true

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22
Q

A___ p___ during labor is recommended for PDA

A

antibiotic prophylaxis

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23
Q

Most common cyanotic heart disease present during
pregnancy; & the primary cause of right-to-left shunting of
blood

A

tetralogy of fallot - TOF

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24
Q

TOF is combination of what 4 defects

A

VSD
pulmonary valve stenosis
right ventricular hypertrophy
displacement of aorta toward the RV

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25
untreated TOF symptoms
cyanosis clubbing of fingers inability to tolerate activity
26
TOF Cardiac complications during pregnancy: ___%
12%
27
complications of TOF
- arrhythmia, heart failure - thrombo-embolism - progressive root dilatation - endocarditis - dysfunction of RV - pulmonary regurgitation - increase in RV size
28
TOF management
- surgical repair (homograft) - monthly echocardiography - diuretics and bed rest - transcatheter valve implantation - early delivery
29
true or false - Women with repaired tetralogy of Fallot usually don't tolerate pregnancy well because of the risk of rupture
false
30
* Localized narrowing of the aorta near the insertion of the ductus arteriosus * an example of an acyanotic congenital heart lesion
coarctation of the aorta
31
* Manifestations: hypertension in the upper extremities but hypotension in the lower extremities * Maternal mortality rate is approximately 3% for the uncorrected defects
coarctation of the aorta
32
complications of COA
hypertension heart failure aortic dissection (rupture/tear) rupture of associated cranial berry aneurysm hemorrhagic stroke ischemic heart disease (associated with HTN and infective endocarditis)
33
treatment of COA during pregnancy
rest antihypertensive meds
34
what is recommended for birth in COA
vaginal birth with epidural vacuum extraction or use of forceps
35
results when recurrent inflammation from bouts of rheumatic fever causes scarring formation on the valves, resulting to stenosis & regurgitation
rheumatic heart disease
36
RHD is Damage from untreated Rheumatic Fever, caused by ___
group A beta-hemolytic streptococcal throat infection
37
Episodes of rheumatic fever create an ___ in the heart tissue that leads to permanent damage of heart valves
autoimmune reaction
38
common site for stenosis during RHD
mitral valve
39
clinical manifestation of RHD
dyspnea orthopnea pulmonary edema + increased risk for CHF
40
first warnings of heart failure
rales dyspnea cough and hemoptysis progressive edema tachycardia
41
* A consequence of rheumatic fever * Narrowing of the opening of the mitral valve caused by stiffening of valve leaflets, which obstructs blood flow from the atrium to the ventricle
mitral stenosis
42
Manifestations: pulmonary edema, atrial fibrillation, right sided failure, infective endocarditis, pulmonary embolism & massive hemoptysis
mitral stenosis
43
recommended position for birth with mitral stenosis
side lying
44
how to decrease cardiac workload with mitral stenosis during labor
vacuum or forcep assisted birth
45
in mitral stenosis, ___ maybe necessary for some women during the intrapartum period.
central hemodynamic monitoring
46
The mitral valve leaflets prolapsed into the left atrium during ventricular systole, allowing some backflow of blood.
mitral valve prolapse
47
MVP clinical manifestations * M___-s___ click & L___-s___ murmur are hallmark signs of this condition * D___ * Chest P___ * P____ * A___ * D___ upon exertion * S___
mid-systolic, late systolic dysrhythmias pain palpitations anxiety dyspnea syncope
48
MVP management
- prophylactic antibiotics - beta blockers - restricted activity - low sodium intake - diuretics and vasodilators
49
what meds are given to women with symptomatic heart failure (MVP)
nitrates, hydralazine, diuretics, digoxin
50
fetal outcome with MVP
low APGAR increase preterm delivery rate intrauterine growth restriction LBW
51
A dysfunction of the LV that occurs in the last month of pregnancy or the 1st 5 months postpartum in a woman with no previous history of heart disease
peripartum and postpartum cardiomyopathy
52
mortality rate of peripartum and postpartum cardiomyopathy
18-56%
53
true or false - A woman develops signs of myocardial failure similar to those of CHF
true
54
PPCM - Subsequent pregnancy is strongly ___ as the disease can recur during this event
discouraged
55
management for PPCM
vaginal delivery if stable hemodynamic monitoring epidural analgesia urgent delivery CS recommended with combined spinal and epidural
56
is defined as a diseased condition which is caused by reduced blood flow in a coronary artery due to atherosclerosis & occlusion of an artery by an embolus or thrombus.
myocardial infarction
57
is the irreversible damage of myocardial tissue caused by prolonged ischaemia & hypoxia.
MI / heart attack
58
MI occurs in ___/10,000 pregnancies
1
59
MI Occurs most frequently in the ___ trimester of pregnancy & in women older than ___ years of age
last; 33
60
Maternal mortality rate from an MI during pregnancy is approximately ___%
20
61
* Characterized as right to left sided atrial or ventricular septal defect with accompanying pulmonary stenosis * Develops when pulmonary resistance equals or exceeds systemic resistance to blood flow
eisenmenger syndrome
62
eisenmenger syndrome - ___ occurs as deoxygenated blood that should go to the lungs is pushed into the systemic circulation.
tissue hypoxia
63
untreated eisenmenger = ??
advised not to get pregnant
64
management of eisenmenger
bed rest anticoagulation prophylaxis diuretics supplemental iron frequent O2 and CBC early CS if fetal condition is bad
65
* Enter pregnancy with elevated blood pressure (140/90 mmHg or above.
chronic hypertensive vascular disease
66
what is prescribed to CHVD
beta blockers calcium channel blockers labetalol nifedipine
67
a device that replaces a damaged or diseased heart valve
artificial valve prosthesis
68
management for artificial valve prosthesis
low molecular weight heparin therapy
69
what to WOF in women taking anticoagulants
petechiae, premature separation of placenta
70
Uncompromised. Ordinary physical activity causes no discomfort. No symptoms of cardiac insufficiency & no angina pain
Class 1
71
Slightly compromised. Ordinary physical activity causes excessive fatigue, palpitation, & dyspnea or angina pain
Class 2
72
Markedly compromised. During less than ordinary activity, woman experiences excessive fatigue, palpitations, dyspnea, or angina pain
Class 3
73
Severely compromised. Woman is unable to carry out any physical activity without experiencing discomfort. Even at rest symptoms of cardiac insufficiency or angina pain are present
Class 4
74
Cardiac surgery may be performed. Early in the ___ is the best time to perform the surgery
2nd trimester
75
Open heart surgery requires ___ & under these circumstances, hypoxia & fetal bradycardia may occur as low bloodflow rates.
extracorporeal circulation
76
true or false - Closed cardiac surgery such as the release of a stenotic mitral orifice cannot be accomplished
false
77
after CS delivery with cardiac problems, what is needed to be done?
after delivery of placenta, add 500 ml of blood to the intravascular volume
78
true or false - The uterus should not be massaged
true
79
signs of circulatory overload
bounding pulse distended neck and peripheral veins rales in lungs
80
postpartum management
anticogaulant and digoxin therapy anti-embolic stockings antibiotcs kegels and stool softener

CARE OF MOTHER, CHILD, AND AT RISK (ACUTE AND CHRONIC) (55 decks)

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