CARDIOVASCULAR DISORDERS (based on T)

Question 1

What are the factors contributing to the increasing prevalence of cardiovascular disorders?

Answer 1

Higher rates of obesity, hypertension, and diabetes.

Question 2

By how much does cardiac output increase during pregnancy?

Answer 2

Approximately 40%.

Question 3

When is cardiac output maximal during pregnancy?

Answer 3

By mid-pregnancy, around 8 weeks gestation.

Question 4

What physiological change drives the early rise in cardiac output during pregnancy?

Answer 4

Augmented stroke volume due to lowered vascular resistance.

Question 5

What happens to resting pulse and stroke volume later in pregnancy?

Answer 5

They increase due to greater end-diastolic ventricular volume from augmented pregnancy blood volume.

Question 6

When does heart failure commonly develop during pregnancy?

Answer 6

After 28 weeks gestation or peripartum.

Question 7

What changes occur in ventricular function during pregnancy?

Answer 7

Ventricular volumes and mass increase to accommodate pregnancy-induced hypervolemia, with unchanged septal thickness and ejection fraction.

Question 8

How does left-ventricular mass change near term?

Answer 8

Left-ventricular mass expands eccentrically by 30-35%.

Question 9

What is the cardiac output formula?

Answer 9

Cardiac Output = Heart Rate (HR) x Stroke Volume (SV).

Question 10

What is the upper limit of heart rate in a pregnant patient?

Answer 10

110 bpm.

Question 11

How does cardiac remodeling differ between non-pregnant and pregnant individuals?

Answer 11

Non-pregnant: Longitudinal remodeling with normal deformation indices. Pregnant: Spherical remodeling with decreased longitudinal deformation indices.

Question 12

How much does cardiac output increase during labor and delivery?

Answer 12

By 50%.

Question 13

How much does blood volume increase with each contraction during labor and delivery?

Answer 13

By 300-500 mL.

Question 14

What happens to systemic vascular resistance during pregnancy, labor, and postpartum?

Answer 14

Pregnancy: Decreases. Labor: Increases. Postpartum: Returns to baseline.

Question 15

What ECG changes are common in pregnancy?

Answer 15

15-degree left axis deviation, frequent atrial and ventricular premature contractions, and unchanged voltage findings.

Question 16

What echocardiographic changes are seen in normal pregnancy?

Answer 16

Slight increase in dimensions of cardiac chambers, growth in left ventricular mass, and greater tricuspid and mitral valve regurgitation.

Question 17

What are clinical symptoms of heart disease during pregnancy?

Answer 17

Progressive dyspnea, orthopnea, nocturnal cough, hemoptysis, syncope, and chest pain.

Question 18

What clinical findings suggest heart disease during pregnancy?

Answer 18

Cyanosis, clubbing, persistent neck vein distention, grade ≥3/6 systolic murmur, diastolic murmur, cardiomegaly, persistent arrhythmia, or split-second sound.

Question 19

What is Schamroth’s window test used for?

Answer 19

To check for clubbing of fingers.

Question 20

What is WHO Risk Classification 1 for cardiovascular disease in pregnancy?

Answer 20

Risk no higher than the general population, e.g., small pulmonary stenosis, uncomplicated ventricular septal defect.

Question 21

What conditions fall under WHO Risk Classification 4?

Answer 21

Pulmonary arterial hypertension, severe systemic ventricular dysfunction, and Marfan syndrome with aorta >40 mm.

Question 22

What is NYHA Class I heart failure?

Answer 22

No limitation of physical activity; ordinary activity does not cause undue fatigue, palpitation, or dyspnea.

Question 23

What is NYHA Class IV heart failure?

Answer 23

Unable to perform any physical activity without discomfort; symptoms present even at rest.

Question 24

What is the goal of preconceptional counseling for cardiac patients?

Answer 24

To optimize cardiac function and mitigate complications during pregnancy.

Question 25

What type of approach is recommended for peripartum management of heart disease?

Answer 25

A team approach.

Question 26

What is advised for pregnant patients with Class I and II cardiovascular conditions to avoid infections?

Answer 26

Avoid contact with persons who have respiratory infections and get pneumococcal and influenza vaccines.

Question 27

What is prohibited for all pregnant patients with cardiovascular conditions?

Answer 27

Cigarette smoking.

Question 28

What is recommended for delivery in most patients with heart disease?

Answer 28

Vaginal delivery is preferred.

Question 29

What are the OB indications for cesarean section in patients with heart disease?

Answer 29

Dystocia, CPD, or outright CS for conditions like dilated aortic root aneurysm >4 cm, severe CHF, recent MI, or symptomatic aortic stenosis.

Question 30

What position is recommended during labor for patients with heart disease?

Answer 30

Semi-recumbent position with lateral tilt (left lateral decubitus).

Question 31

What maternal vital signs during labor may indicate impending ventricular failure?

Answer 31

Pulse rate >100 bpm and respiratory rate >24 breaths per minute with dyspnea.

Question 32

What type of analgesia is recommended for vaginal delivery in women with mild cardiovascular compromise?

Answer 32

Epidural analgesia with IV sedation.

Question 33

What complications can lead to intrapartum heart failure?

Answer 33

Pulmonary edema, hypoxia, hypotension, preeclampsia, chronic hypertension, and obesity.

Question 34

What complications are serious in the puerperium for women with heart disease?

Answer 34

Postpartum hemorrhage, anemia, infection, and thromboembolism.

Question 35

What anticoagulation therapy is contraindicated during pregnancy due to teratogenicity?

Answer 35

Warfarin.

Question 36

What anticoagulation therapy is safer for the fetus but increases maternal thromboembolic risk?

Answer 36

Heparin.

Question 37

What is the preferred anticoagulant postpartum after delivery for heart disease patients?

Answer 37

LMWH, discontinued before delivery and resumed 6 hours after vaginal delivery.

Question 38

What is the maternal mortality rate for prosthetic mitral or aortic valves during pregnancy?

Answer 38

1.2%.

Question 39

What is the primary cause of mitral stenosis?

Answer 39

Rheumatic valvulitis.

Question 40

What happens to the left atrium (LA) in mitral stenosis?

Answer 40

LA dilation and passive pulmonary hypertension occur.

Question 41

How is mitral insufficiency caused?

Answer 41

By rheumatic valvulitis or mitral valve prolapse.

Question 42

What is the pathophysiology of aortic stenosis?

Answer 42

Left ventricular (LV) concentric hypertrophy and decreased cardiac output.

Question 43

What is the primary cause of aortic insufficiency?

Answer 43

Rheumatic valvulitis, connective tissue disease, or congenital causes.

Question 44

What is the most common type of heart disease encountered during pregnancy?

Answer 44

Congenital heart disease.

Question 45

What complications are associated with atrial septal defect during pregnancy?

Answer 45

Risk of thromboembolism and cyanosis from deoxygenated blood in the left atrium.

Question 46

How does the size of a ventricular septal defect affect pregnancy outcomes?

Answer 46

Defects <1.25 cm² are asymptomatic; defects >1.25 cm² can cause pulmonary hypertension and heart failure.

Question 47

What is Eisenmenger syndrome?

Answer 47

Secondary pulmonary hypertension where pulmonary vascular resistance exceeds systemic resistance, causing deoxygenated blood to bypass the lungs.

Question 48

What is the resting mean pulmonary pressure in non-pregnant patients with pulmonary hypertension?

Answer 48

Greater than 25 mmHg.

Question 49

What is the most frequent symptom of pulmonary hypertension?

Answer 49

Dyspnea with exertion.

Question 50

What symptoms suggest advanced pulmonary hypertension?

Answer 50

Angina and syncope due to fixed right ventricular output.

Question 51

What chest X-ray findings are associated with pulmonary hypertension?

Answer 51

Enlarged pulmonary hilar arteries and attenuated peripheral markings.

Question 52

What is the final common pathway in pulmonary hypertension prognosis?

Answer 52

Right heart failure and death.

Question 53

What is the average survival length after a pulmonary hypertension diagnosis?

Answer 53

Less than 4 years.

Question 54

What type of pulmonary hypertension has the worst prognosis during pregnancy?

Answer 54

Idiopathic pulmonary arterial hypertension.

Question 55

What maternal mortality rate is associated with pulmonary hypertension during pregnancy?

Answer 55

Appreciable.

Question 56

What are some management strategies for pulmonary hypertension during pregnancy?

Answer 56

Limit activity, avoid supine position, use diuretics cautiously, supplemental oxygen, pulmonary vasodilators, and anticoagulants like Aspirin or Clopidogrel.

Question 57

What is the hallmark characteristic of hypertrophic cardiomyopathy?

Answer 57

Left ventricular myocardial hypertrophy with a pressure gradient against the left ventricle.

Question 58

What are the characteristics of hypertrophic cardiomyopathy on 2D echocardiography?

Answer 58

Hypertrophic and dilated left ventricle in the absence of cardiovascular conditions.

Question 59

What is the management for angina in hypertrophic cardiomyopathy?

Answer 59

Beta adrenergic or calcium channel blockers.

Question 60

What is the most common type of cardiomyopathy associated with pregnancy?

Answer 60

Peripartum cardiomyopathy.

Question 61

When does peripartum cardiomyopathy typically develop?

Answer 61

In the last month of pregnancy or within 5 months after delivery.

Question 62

What is the mortality rate for persistent cardiac failure in peripartum cardiomyopathy?

Answer 62

85% over 5 years.

Question 63

What type of cardiomyopathy involves progressive replacement of right ventricular myocardium with adipose and fibrous tissue?

Answer 63

Arrhythmogenic right ventricular dysplasia.

Question 64

What are common symptoms of heart failure during pregnancy?

Answer 64

Dyspnea, orthopnea, palpitations, nocturnal cough, and substernal chest pain.

Question 65

What chest X-ray findings are hallmarks of heart failure?

Answer 65

Cardiomegaly and pulmonary edema.

Question 66

What is the most common cause of infective endocarditis during pregnancy?

Answer 66

Streptococcal and Staphylococcal infections.

Question 67

What clinical clues suggest infective endocarditis?

Answer 67

Anemia, proteinuria, petechiae, focal neurologic changes, and embolic lesions.

Question 68

What are the Duke criteria for diagnosing infective endocarditis?

Answer 68

Positive blood culture, evidence of endocardial involvement, and imaging findings.

Question 69

What are the risk factors for arrhythmias during pregnancy?

Answer 69

Tachycardia, psychological stress, and underlying heart disease.

Question 70

What is the acute treatment for supraventricular tachycardia (SVT) during pregnancy?

Answer 70

Valsalva maneuver, vagal massage, or carotid sinus massage.

Question 71

What medication is safe and effective for treating hemodynamically stable SVT during pregnancy?

Answer 71

Adenosine.

Question 72

What treatment is recommended for unstable ventricular tachycardia during pregnancy?

Answer 72

Emergency cardioversion.

Question 73

What medications can prolong the QT interval and predispose to torsades de pointes?

Answer 73

Azithromycin, Erythromycin, and Clarithromycin.

Question 74

What are the classic symptoms of aortic dissection?

Answer 74

Severe chest pain described as ripping, tearing, or stabbing.

Question 75

What is the hallmark clinical sign of aortic dissection?

Answer 75

Unequal blood pressure readings between the left and right sides.

Question 76

What are the main cardiovascular complications of Marfan syndrome during pregnancy?

Answer 76

Aortic dilation and dissecting aneurysm.

Question 77

What is the recommended monitoring frequency for aortic dimensions in Marfan syndrome during pregnancy?

Answer 77

Monthly or bimonthly echocardiograms.

Question 78

What are the complications of aortic coarctation?

Answer 78

Congestive heart failure, bacterial endocarditis of the bicuspid aortic valve, and aortic rupture.

Question 79

What is the main diagnostic method for myocardial infarction during pregnancy?

Answer 79

ECG and elevated troponin levels.

Question 80

What is the treatment for myocardial infarction during pregnancy?

Answer 80

Same as in non-pregnant patients.