CARDIOVASCULAR DISORDERS (based on T) Flashcards
What are the factors contributing to the increasing prevalence of cardiovascular disorders?
Higher rates of obesity, hypertension, and diabetes.
By how much does cardiac output increase during pregnancy?
Approximately 40%.
When is cardiac output maximal during pregnancy?
By mid-pregnancy, around 8 weeks gestation.
What physiological change drives the early rise in cardiac output during pregnancy?
Augmented stroke volume due to lowered vascular resistance.
What happens to resting pulse and stroke volume later in pregnancy?
They increase due to greater end-diastolic ventricular volume from augmented pregnancy blood volume.
When does heart failure commonly develop during pregnancy?
After 28 weeks gestation or peripartum.
What changes occur in ventricular function during pregnancy?
Ventricular volumes and mass increase to accommodate pregnancy-induced hypervolemia, with unchanged septal thickness and ejection fraction.
How does left-ventricular mass change near term?
Left-ventricular mass expands eccentrically by 30-35%.
What is the cardiac output formula?
Cardiac Output = Heart Rate (HR) x Stroke Volume (SV).
What is the upper limit of heart rate in a pregnant patient?
110 bpm.
How does cardiac remodeling differ between non-pregnant and pregnant individuals?
Non-pregnant: Longitudinal remodeling with normal deformation indices. Pregnant: Spherical remodeling with decreased longitudinal deformation indices.
How much does cardiac output increase during labor and delivery?
By 50%.
How much does blood volume increase with each contraction during labor and delivery?
By 300-500 mL.
What happens to systemic vascular resistance during pregnancy, labor, and postpartum?
Pregnancy: Decreases. Labor: Increases. Postpartum: Returns to baseline.
What ECG changes are common in pregnancy?
15-degree left axis deviation, frequent atrial and ventricular premature contractions, and unchanged voltage findings.
What echocardiographic changes are seen in normal pregnancy?
Slight increase in dimensions of cardiac chambers, growth in left ventricular mass, and greater tricuspid and mitral valve regurgitation.
What are clinical symptoms of heart disease during pregnancy?
Progressive dyspnea, orthopnea, nocturnal cough, hemoptysis, syncope, and chest pain.
What clinical findings suggest heart disease during pregnancy?
Cyanosis, clubbing, persistent neck vein distention, grade ≥3/6 systolic murmur, diastolic murmur, cardiomegaly, persistent arrhythmia, or split-second sound.
What is Schamroth’s window test used for?
To check for clubbing of fingers.
What is WHO Risk Classification 1 for cardiovascular disease in pregnancy?
Risk no higher than the general population, e.g., small pulmonary stenosis, uncomplicated ventricular septal defect.
What conditions fall under WHO Risk Classification 4?
Pulmonary arterial hypertension, severe systemic ventricular dysfunction, and Marfan syndrome with aorta >40 mm.
What is NYHA Class I heart failure?
No limitation of physical activity; ordinary activity does not cause undue fatigue, palpitation, or dyspnea.
What is NYHA Class IV heart failure?
Unable to perform any physical activity without discomfort; symptoms present even at rest.
What is the goal of preconceptional counseling for cardiac patients?
To optimize cardiac function and mitigate complications during pregnancy.
What type of approach is recommended for peripartum management of heart disease?
A team approach.
What is advised for pregnant patients with Class I and II cardiovascular conditions to avoid infections?
Avoid contact with persons who have respiratory infections and get pneumococcal and influenza vaccines.
What is prohibited for all pregnant patients with cardiovascular conditions?
Cigarette smoking.
What is recommended for delivery in most patients with heart disease?
Vaginal delivery is preferred.
What are the OB indications for cesarean section in patients with heart disease?
Dystocia, CPD, or outright CS for conditions like dilated aortic root aneurysm >4 cm, severe CHF, recent MI, or symptomatic aortic stenosis.
What position is recommended during labor for patients with heart disease?
Semi-recumbent position with lateral tilt (left lateral decubitus).
What maternal vital signs during labor may indicate impending ventricular failure?
Pulse rate >100 bpm and respiratory rate >24 breaths per minute with dyspnea.
What type of analgesia is recommended for vaginal delivery in women with mild cardiovascular compromise?
Epidural analgesia with IV sedation.
What complications can lead to intrapartum heart failure?
Pulmonary edema, hypoxia, hypotension, preeclampsia, chronic hypertension, and obesity.
What complications are serious in the puerperium for women with heart disease?
Postpartum hemorrhage, anemia, infection, and thromboembolism.
What anticoagulation therapy is contraindicated during pregnancy due to teratogenicity?
Warfarin.
What anticoagulation therapy is safer for the fetus but increases maternal thromboembolic risk?
Heparin.
What is the preferred anticoagulant postpartum after delivery for heart disease patients?
LMWH, discontinued before delivery and resumed 6 hours after vaginal delivery.
What is the maternal mortality rate for prosthetic mitral or aortic valves during pregnancy?
1.2%.
What is the primary cause of mitral stenosis?
Rheumatic valvulitis.
What happens to the left atrium (LA) in mitral stenosis?
LA dilation and passive pulmonary hypertension occur.
How is mitral insufficiency caused?
By rheumatic valvulitis or mitral valve prolapse.
What is the pathophysiology of aortic stenosis?
Left ventricular (LV) concentric hypertrophy and decreased cardiac output.
What is the primary cause of aortic insufficiency?
Rheumatic valvulitis, connective tissue disease, or congenital causes.
What is the most common type of heart disease encountered during pregnancy?
Congenital heart disease.
What complications are associated with atrial septal defect during pregnancy?
Risk of thromboembolism and cyanosis from deoxygenated blood in the left atrium.
How does the size of a ventricular septal defect affect pregnancy outcomes?
Defects <1.25 cm² are asymptomatic; defects >1.25 cm² can cause pulmonary hypertension and heart failure.
What is Eisenmenger syndrome?
Secondary pulmonary hypertension where pulmonary vascular resistance exceeds systemic resistance, causing deoxygenated blood to bypass the lungs.
What is the resting mean pulmonary pressure in non-pregnant patients with pulmonary hypertension?
Greater than 25 mmHg.
What is the most frequent symptom of pulmonary hypertension?
Dyspnea with exertion.
What symptoms suggest advanced pulmonary hypertension?
Angina and syncope due to fixed right ventricular output.
What chest X-ray findings are associated with pulmonary hypertension?
Enlarged pulmonary hilar arteries and attenuated peripheral markings.
What is the final common pathway in pulmonary hypertension prognosis?
Right heart failure and death.
What is the average survival length after a pulmonary hypertension diagnosis?
Less than 4 years.
What type of pulmonary hypertension has the worst prognosis during pregnancy?
Idiopathic pulmonary arterial hypertension.
What maternal mortality rate is associated with pulmonary hypertension during pregnancy?
Appreciable.
What are some management strategies for pulmonary hypertension during pregnancy?
Limit activity, avoid supine position, use diuretics cautiously, supplemental oxygen, pulmonary vasodilators, and anticoagulants like Aspirin or Clopidogrel.
What is the hallmark characteristic of hypertrophic cardiomyopathy?
Left ventricular myocardial hypertrophy with a pressure gradient against the left ventricle.
What are the characteristics of hypertrophic cardiomyopathy on 2D echocardiography?
Hypertrophic and dilated left ventricle in the absence of cardiovascular conditions.
What is the management for angina in hypertrophic cardiomyopathy?
Beta adrenergic or calcium channel blockers.
What is the most common type of cardiomyopathy associated with pregnancy?
Peripartum cardiomyopathy.
When does peripartum cardiomyopathy typically develop?
In the last month of pregnancy or within 5 months after delivery.
What is the mortality rate for persistent cardiac failure in peripartum cardiomyopathy?
85% over 5 years.
What type of cardiomyopathy involves progressive replacement of right ventricular myocardium with adipose and fibrous tissue?
Arrhythmogenic right ventricular dysplasia.
What are common symptoms of heart failure during pregnancy?
Dyspnea, orthopnea, palpitations, nocturnal cough, and substernal chest pain.
What chest X-ray findings are hallmarks of heart failure?
Cardiomegaly and pulmonary edema.
What is the most common cause of infective endocarditis during pregnancy?
Streptococcal and Staphylococcal infections.
What clinical clues suggest infective endocarditis?
Anemia, proteinuria, petechiae, focal neurologic changes, and embolic lesions.
What are the Duke criteria for diagnosing infective endocarditis?
Positive blood culture, evidence of endocardial involvement, and imaging findings.
What are the risk factors for arrhythmias during pregnancy?
Tachycardia, psychological stress, and underlying heart disease.
What is the acute treatment for supraventricular tachycardia (SVT) during pregnancy?
Valsalva maneuver, vagal massage, or carotid sinus massage.
What medication is safe and effective for treating hemodynamically stable SVT during pregnancy?
Adenosine.
What treatment is recommended for unstable ventricular tachycardia during pregnancy?
Emergency cardioversion.
What medications can prolong the QT interval and predispose to torsades de pointes?
Azithromycin, Erythromycin, and Clarithromycin.
What are the classic symptoms of aortic dissection?
Severe chest pain described as ripping, tearing, or stabbing.
What is the hallmark clinical sign of aortic dissection?
Unequal blood pressure readings between the left and right sides.
What are the main cardiovascular complications of Marfan syndrome during pregnancy?
Aortic dilation and dissecting aneurysm.
What is the recommended monitoring frequency for aortic dimensions in Marfan syndrome during pregnancy?
Monthly or bimonthly echocardiograms.
What are the complications of aortic coarctation?
Congestive heart failure, bacterial endocarditis of the bicuspid aortic valve, and aortic rupture.
What is the main diagnostic method for myocardial infarction during pregnancy?
ECG and elevated troponin levels.
What is the treatment for myocardial infarction during pregnancy?
Same as in non-pregnant patients.
