CCS Pregnancy Guidelines 2021 Flashcards
How much does Pregnancy increase CO? When does it peak?
- 40%
- 3rd trimester
What is maternal mortality in canada?
< 1%
What is better: CARPREG II or WHO?
Carpreg II is more accurate than WHO or Carpreg 1
What are 4 Functional Predictors in CARPREG II?
- Cardiac Event (HF, ACS, TIA/Stroke, Arrhythmia)
- Baseline NYHA III or IV or Cyanosis
- LVEF < 55%
- LVOT Obstruction > 30mmhg, MVA < 2, AVA < 1.5
What are 3 lesion specific predictors in CARPREG II?
Mechanical Valve
Pulmonary Hypertension (RVSP > 50mmhg)
Coronary Artery Disease
High Risk Aortopathy (BAV > 4.5 cm, LD, Vascular ED, Previous Dissection)
What are 2 Process predictors in CARPREG II?
- No prior cardiac interventions
- Late pregnancy assessment ( > 20 weeks GA)
What is good way to remember the estimation for CV complications for CARPREG II?
Multiply score by 5, when >4 multiply by 10
What are 7 high risk cardiac lesions?
- 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
What two arrhythmia meds are CI in breast feeding?
- Amiodarone
- Ivabradine
What 3 ACEi are ok in breast feeding?
Captopril
Lisinopril
Enalapril
What class of blood thinners are CI in breast feeding?
DOACS
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?
- Warfarin
- Crosses placenta and can cause embryopathy and issues with organogenesis in first trimester
What are 6 RFs for PPCM?
- AA
- Twin
- Maternal Age
- Preeclampsia
- Smoking
- Diabetes
Are thrombolytics safe in Pregnancy?
Yes- Do not cross the placenta
When during Cardiac Arrest resusc should C section be done?
4 mins with no ROSC
What is ICD/PPM check up frequency around pregnancy?
Once at baseline/beefore preg and then at least once throughout
What three anti-arrhythmics are CI during pregnancy?
Amiodarone, Ivabradine, Atenolol
What is risk of suffering ischemic event if already has ASSCVD during pregnancy?
10%
What % of maternal mortality is Aortic Dissection associated with?
30%
When to have prophylactic Aortic root surgery in BAV?
5 cm
When to have prophylactic Aortic root surgery in MFS?
4.5 cm
When to have prophylactic Aortic root surgery in LD?
4.5 cm, although pregnancy not recommended at any size
What determines in AD whether Aortic surgery should be done with fetus in utero?
- If Fetus viable = C section first
- If Fetus non viable = Aortic repair first
In Women with CHD, name 8 Complex congenital disease?
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
How frequent Aortic survillance in pregnancy with TAA’s?
-q4-12 weeks in pregnancy and q3-6 months post partum
What % of population has CHD?
1%
How to decide if high risk?
If high risk lesion -> High Risk
If no high risk lesion -> CARPREG 2 -> risk stratify
What LV enhancement is OK to use when Breast feeding?
No ACEi other than: Captopril, Lisinopril, Enalapril
Beta Blockers (other then Atenolol)
NO MRA, ARNI, Ivaradine, SGLT2 inhibitor
Review the pros and cons of VKA, LMWH and UFH in pregnancy
How would you treat ACS in pregnancy?
- Aspirin, UFH/Enox, Beta blocker (Not Atenolol), Nitrates
- Clopidogrel (Limited evidence but OK post PCI)
- No statin, No ACEi, No DOAC
Are Class Ic’s and Sotalol OK in Pregnancy?
Yes
Review High Risk Congenital lesions in pregnancy
4 reasons to recommend C Section (although not absolutely contraindicated)
- VKA
- Severe PHTn
- Decompensated HF
- High risk Aortopathy
