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?

19
Q

What % of maternal mortality is Aortic Dissection associated with?

20
Q

When to have prophylactic Aortic root surgery in BAV?

21
Q

When to have prophylactic Aortic root surgery in MFS?

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
How frequent Aortic survillance in pregnancy with TAA's?
-q4-12 weeks in pregnancy and q3-6 months post partum
26
What % of population has CHD?
1%
27
How to decide if high risk?
If high risk lesion -> High Risk If no high risk lesion -> CARPREG 2 -> risk stratify
28
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
29
Review the pros and cons of VKA, LMWH and UFH in pregnancy
30
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
31
Are Class Ic's and Sotalol OK in Pregnancy?
Yes
32
Review High Risk Congenital lesions in pregnancy
33
4 reasons to recommend C Section (although not absolutely contraindicated)
- VKA - Severe PHTn - Decompensated HF - High risk Aortopathy