Cardiovascular Disorders and Pregnancy Flashcards
Peripartum heart disease is rare(true or false)
true
Most common CVDs in pregnancy(4)
- damage caused by rheumatic fever or Kawasaki disease
- Atrial septal defect or uncorrected coarctation of the aorta
- Aortic dilation from Marfan syndrome
- Coronary artery disease (CAD) and varicosities (advanced age)
Blood volume increase during pregnancy:
30%-50%
Most dangerous time
week 28 to 32
(CLASSIFICATION of HEART DISEASE)
Ordinary physical activity causes no discomfort. No symptoms
of cardiac insufficiency and no anginal pain.
Uncompromised.
(CLASSIFICATION of HEART DISEASE)
Ordinary physical activity causes excessive fatigue,
palpitation, and dyspnea or anginal pain.
Slightly compromised.
(CLASSIFICATION of HEART DISEASE)
Woman is unable to carry out any physical activity
without experiencing discomfort. Even at rest, symptoms of cardiac
insufficiency or anginal pain are present.
Severely compromised.
(CLASSIFICATION of HEART DISEASE)
During less than ordinary activity, woman experiences
excessive fatigue, palpitations, dyspnea, or anginal pain.
Markedly compromised.
- Mitral stenosis, mitral insufficiency, aortic coarctation
- Left ventricle cannot move large volume of blood, causing distention (left side), lowered CO, and pulmonary hypertension
- When pulmonary vein reaches 25 mmHg, fluid leaks into the interstitial space into and surrounding alveoli – pulmonary edema
- Thrombus formation from noncirculating blood
A woman with Left-Sided Heart Failure
- Caused by pulmonary valve stenosis, Eisenmenger syndrome, -
- right-to-left atrial or ventricular septal defect
- Congestion of systemic venous circulation
- ↓cardiac output to the lungs
- ↓ BP in the aorta
- ↑ BP in the vena cava
A woman with Right-Sided Heart Failure
- Distention of liver and spleen – dyspnea and pain
- Distention of abdominal and lower extremity vessels – exudate of fluid from vessels into peritoneal cavity – ascites or peripheral edema
- May not be advised to get pregnant
A woman with Right-Sided Heart Failure
- May be caused by the stress of pregnancy in the circulatory system
- Mortality: as high as 50%
- S/S: shortness of breath, chest pain, nondependent edema, cardiomegaly
- Tx: reduce physical activities, diuretics, arrhythmia agent, digitalis therapy, heparin
- Peripartal Cardiomyopathy- originates in pregnancy
A woman with Peripartum Heart Disease
Preterm labor – ?
immature fetus
Poor placental perfusion – ?
late deceleration
- Promote rest
- Promote healthy nutrition
- Educate regarding medication
- Educate regarding avoidance of infection
- Be prepared for emergency actions
Interventions: Prepartum
- Monitor VS, uterine contractions
- Side-lying to reduce supine hypotension
- If with pulmonary edema – semi-fowler’s
- O2 administration
- Epidural anesthesia (anesth. Of choice) – to decrease sensation of pushing
Interventions: Intrapartum
- Decreased activity
- Anticoagulant and digoxin therapy
- Antiembolic stockings
- Prophylactic antibiotics
- Stool softener
Interventions: Postpartum
- Low-molecular-weight heparin before and during pregnancy
- Observe pt. for petechiae and premature separation of placenta
A Woman with an Artificial Valve Prosthesis
- Elevated BP (140/90 mmHg or )
- Associated with arteriosclerosis or renal disease
- ↑ risk due to poor kidney, heart, and placental perfusion
- Tx: B-blockers, Ca Channel Blockers to BP (labetalol and nifedipine)
A woman with Chronic Hypertensive Vascular Disease
- Incidence ↑ because of blood stasis and hypercoagulability of estrogen
- Stasis + vessel damage + hypercoagulation = ↑ risk of DVT
A Woman with Venous Thromboembolic Disease
Intervention
- Avoid constrictive knee-high stockings
- Avoid crossing legs while sitting
- Avoid standing for long period
- Bed rest; IV heparin for 24-48 hrs
- Anti-Xa Test – most accurate assay for monitoring heparin
A Woman with Venous Thromboembolic Disease
