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RCE Guidelines Studying > CCS Pregnancy Guidelines 2021 > Flashcards

CCS Pregnancy Guidelines 2021 Flashcards

1
Q

How much does Pregnancy increase CO? When does it peak?

A
  • 40%

- 3rd trimester

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2
Q

What is maternal mortality in canada?

A

< 1%

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3
Q

What is better: CARPREG II or WHO?

A

Carpreg II is more accurate than WHO or Carpreg 1

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4
Q

What are 4 Functional Predictors in CARPREG II?

A
  • Cardiac Event (HF, ACS, TIA/Stroke, Arrhythmia)
  • Baseline NYHA III or IV or Cyanosis
  • LVEF < 55%
  • LVOT Obstruction > 30mmhg, MVA < 2, AVA < 1.5
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5
Q

What are 3 lesion specific predictors in CARPREG II?

A

Mechanical Valve

Pulmonary Hypertension (RVSP > 50mmhg)

Coronary Artery Disease

High Risk Aortopathy (BAV > 4.5 cm, LD, Vascular ED, Previous Dissection)

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6
Q

What are 2 Process predictors in CARPREG II?

A
  • No prior cardiac interventions

- Late pregnancy assessment ( > 20 weeks GA)

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7
Q

What is good way to remember the estimation for CV complications for CARPREG II?

A

Multiply score by 5, when >4 multiply by 10

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8
Q

What are 7 high risk cardiac lesions?

A
  • Eisenmenger or Severe Pulmonary HTN
  • Prior peripartum CMO with reduced LVEF
  • Severe Hereditary thoracic aortopathy (BAV > 5, Turner > 25 mm/m2, MFS > 4.5, Vascular EDS, LD)
  • Symptomatic severe Aortic or Mitral stenosis
  • LVEF < 30% or VAD
  • Fontan procedure with arrhythmia, ventricular dysfunction or complication
  • Coronary artery dissection
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9
Q

What two arrhythmia meds are CI in breast feeding?

A
  • Amiodarone

- Ivabradine

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10
Q

What 3 ACEi are ok in breast feeding?

A

Captopril

Lisinopril

Enalapril

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11
Q

What class of blood thinners are CI in breast feeding?

A

DOACS

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12
Q

What choice of AC is associated with the least amount of valve thrombosis/CV events in pregnancy with mechanical valve? What is the down side?

A
  • Warfarin

- Crosses placenta and can cause embryopathy and issues with organogenesis in first trimester

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13
Q

What are 6 RFs for PPCM?

A
  • AA
  • Twin
  • Maternal Age
  • Preeclampsia
  • Smoking
  • Diabetes
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14
Q

Are thrombolytics safe in Pregnancy?

A

Yes- Do not cross the placenta

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15
Q

When during Cardiac Arrest resusc should C section be done?

A

4 mins with no ROSC

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16
Q

What is ICD/PPM check up frequency around pregnancy?

A

Once at baseline/beefore preg and then at least once throughout

17
Q

What three anti-arrhythmics are CI during pregnancy?

A

Amiodarone, Ivabradine, Atenolol

18
Q

What is risk of suffering ischemic event if already has ASSCVD during pregnancy?

A

10%

19
Q

What % of maternal mortality is Aortic Dissection associated with?

A

30%

20
Q

When to have prophylactic Aortic root surgery in BAV?

A

5 cm

21
Q

When to have prophylactic Aortic root surgery in MFS?

A

4.5 cm

22
Q

When to have prophylactic Aortic root surgery in LD?

A

4.5 cm, although pregnancy not recommended at any size

23
Q

What determines in AD whether Aortic surgery should be done with fetus in utero?

A
  • If Fetus viable = C section first

- If Fetus non viable = Aortic repair first

24
Q

In Women with CHD, name 8 Complex congenital disease?

A

Unrepaired/palliated cyanotic CHD

Fontan procedure

Single ventricle physiology

Truncus arteriosus

TGA post atrial switch

Double outlet ventricle

Interrupted aortic arch

Other complex AV connections

25
Q

How frequent Aortic survillance in pregnancy with TAA’s?

A

-q4-12 weeks in pregnancy and q3-6 months post partum

26
Q

What % of population has CHD?

A

1%

27
Q

How to decide if high risk?

A

If high risk lesion -> High Risk

If no high risk lesion -> CARPREG 2 -> risk stratify

28
Q

What LV enhancement is OK to use when Breast feeding?

A

No ACEi other than: Captopril, Lisinopril, Enalapril

Beta Blockers (other then Atenolol)

NO MRA, ARNI, Ivaradine, SGLT2 inhibitor

29
Q

Review the pros and cons of VKA, LMWH and UFH in pregnancy

A
30
Q

How would you treat ACS in pregnancy?

A
  • Aspirin, UFH/Enox, Beta blocker (Not Atenolol), Nitrates
  • Clopidogrel (Limited evidence but OK post PCI)
  • No statin, No ACEi, No DOAC
31
Q

Are Class Ic’s and Sotalol OK in Pregnancy?

A

Yes

32
Q

Review High Risk Congenital lesions in pregnancy

A
33
Q

4 reasons to recommend C Section (although not absolutely contraindicated)

A
  • VKA
  • Severe PHTn
  • Decompensated HF
  • High risk Aortopathy

RCE Guidelines Studying (52 decks)

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