Classification and Risk Assessment in Heart Disease During Pregnancy Flashcards
Which NYHA class corresponds to a pregnant woman who experiences symptoms of dyspnea and fatigue during ordinary physical activity but is comfortable at rest?
A. Class I
B. Class II
C. Class III
D. Class IV
B. Class II
Rationale: NYHA Class II indicates mild limitation of physical activity, with symptoms like fatigue, dyspnea, or palpitations occurring with ordinary activity but not at rest.
Buzzwords: Ordinary activity, mild limitation, no symptoms at rest.
A pregnant woman with symptoms of cardiac insufficiency even at rest and inability to perform physical activity belongs to which NYHA class?
A. Class I
B. Class II
C. Class III
D. Class IV
D. Class IV
Rationale: NYHA Class IV involves severe symptoms, even at rest, and an inability to perform any physical activity without discomfort. It is the most severe functional class in heart disease.
Buzzwords: Symptoms at rest, inability to perform activity, severe.
According to the WHO classification of cardiovascular disease in pregnancy, which condition is categorized as WHO Class 1?
A. Severe pulmonary arterial hypertension
B. Mechanical heart valves
C. Repaired congenital heart defect without residual lesion
D. Cyanotic congenital heart disease
C. Repaired congenital heart defect without residual lesion
Rationale: WHO Class 1 includes low-risk conditions like repaired defects with no residual issues, mild valve disease, or conditions that do not significantly affect cardiac function.
Buzzwords: No residual lesion, low risk, routine care.
A pregnant woman with severe left ventricular dysfunction (LVEF <30%) is categorized as which WHO class?
A. WHO 1
B. WHO 2
C. WHO 3
D. WHO 4
D. WHO 4
Rationale: Severe left ventricular dysfunction (LVEF <30%) is a high-risk condition (WHO Class 4), where pregnancy is contraindicated due to the significant risk of morbidity and mortality.
Buzzwords: Severe ventricular dysfunction, LVEF <30%, contraindicated pregnancy.
Which of the following cardiovascular conditions is a contraindication to pregnancy (WHO Class 4)?
A. Mild pulmonary stenosis
B. Repaired atrial septal defect
C. Marfan syndrome with aortic dilation >40 mm
D. Tetralogy of Fallot repair without residual lesions
C. Marfan syndrome with aortic dilation >40 mm
Rationale: WHO Class 4 conditions include Marfan syndrome with aortic dilation, severe pulmonary hypertension, and LVEF <30%, all of which carry high maternal mortality risks.
Buzzwords: Marfan syndrome, aortic dilation >40 mm, contraindicated.
A patient with unoperated atrial septal defect and no pulmonary hypertension falls under which WHO risk class?
A. WHO 1
B. WHO 2
C. WHO 3
D. WHO 4
B. WHO 2
Rationale: Unoperated atrial septal defects without pulmonary hypertension are low-risk conditions (WHO Class 2) but may require regular cardiology follow-ups during pregnancy.
Buzzwords: Unoperated ASD, no pulmonary hypertension, regular follow-ups.
For a pregnant patient with a mechanical heart valve, what is the WHO risk classification, and what management is required?
A. WHO 1, routine antenatal care
B. WHO 2, cardiology follow-up every trimester
C. WHO 3, multidisciplinary care with monthly monitoring
D. WHO 4, contraindicated pregnancy
C. WHO 3, multidisciplinary care with monthly monitoring
Rationale: Mechanical heart valves (WHO Class 3) pose moderate-to-high maternal risk, requiring multidisciplinary care, anticoagulation management, and frequent follow-ups.
Buzzwords: Mechanical valves, multidisciplinary care, anticoagulation risks.
What is the primary difference between NYHA Class III and Class IV in heart disease during pregnancy?
A. Symptoms occur with ordinary activity in Class III and at rest in Class IV.
B. Both involve symptoms only with significant physical activity.
C. Symptoms occur with minimal activity in Class III and are absent in Class IV.
D. Class III includes pulmonary hypertension, while Class IV does not.
A. Symptoms occur with ordinary activity in Class III and at rest in Class IV.
Rationale: NYHA Class III symptoms occur with less than ordinary activity, while Class IV symptoms are present at rest, reflecting a greater functional compromise.
Buzzwords: Class III = ordinary activity; Class IV = at rest, severe.
A pregnant patient with repaired Tetralogy of Fallot and good functional status belongs to which WHO class?
A. WHO 1
B. WHO 2
C. WHO 3
D. WHO 4
B. WHO 2
Rationale: Repaired Tetralogy of Fallot with good functional status is a low-risk condition classified under WHO 2. Regular monitoring is advised.
Buzzwords: Repaired Tetralogy, good function, low risk.
Which NYHA class applies to a pregnant woman who experiences no symptoms during any level of physical activity?
A. Class I
B. Class II
C. Class III
D. Class IV
A. Class I
Rationale: NYHA Class I represents no limitation of physical activity, with no symptoms even during strenuous activity.
Buzzwords: No limitation, asymptomatic, full physical activity.
Pulmonary arterial hypertension in pregnancy is classified as:
A. WHO 1
B. WHO 2
C. WHO 3
D. WHO 4
D. WHO 4
Rationale: Pulmonary arterial hypertension is a high-risk condition (WHO Class 4) with significant maternal and fetal risks, often making pregnancy contraindicated.
Buzzwords: Pulmonary hypertension, high maternal risk, contraindicated.
A pregnant woman with mild mitral valve prolapse, no symptoms, and normal cardiac function is classified as:
A. NYHA Class II, WHO Class 3
B. NYHA Class I, WHO Class 1
C. NYHA Class III, WHO Class 2
D. NYHA Class IV, WHO Class 4
B. NYHA Class I, WHO Class 1
Rationale: Mild mitral valve prolapse with no symptoms and normal cardiac function is low risk, classified as both NYHA I and WHO 1.
Buzzwords: Mitral valve prolapse, asymptomatic, low risk.
What management is recommended for a WHO Class 4 patient who chooses to continue pregnancy despite contraindications?
A. Routine obstetric care with biweekly visits
B. Multidisciplinary care with intensive monitoring
C. Cardiovascular surgery during pregnancy
D. Strict bed rest without additional monitoring
B. Multidisciplinary care with intensive monitoring
Rationale: Patients in WHO Class 4 who proceed with pregnancy require intensive multidisciplinary management to mitigate extremely high risks.
Buzzwords: WHO Class 4, high risk, multidisciplinary intensive monitoring.
Which WHO class includes conditions with a small increase in maternal risk but no contraindication to pregnancy?
A. WHO 1
B. WHO 2
C. WHO 3
D. WHO 4
B. WHO 2
Rationale: WHO Class 2 includes conditions with small risk increases, such as mild valvular disease or repaired congenital defects.
Buzzwords: WHO Class 2, small increase in risk, regular cardiology follow-up.
Which of the following findings would most likely classify a pregnant woman as WHO Class 3?
A. Unoperated atrial septal defect
B. Mild pulmonary stenosis
C. Cyanotic congenital heart disease without pulmonary hypertension
D. Mechanical prosthetic valve
D. Mechanical prosthetic valve
Rationale: WHO Class 3 includes high-risk conditions like mechanical heart valves, requiring intensive monitoring and anticoagulation management.
Buzzwords: Mechanical valve, high risk, WHO Class 3.
Which of the following is a major predictor of cardiac complications during pregnancy?
A. Mild valve obstruction (mitral valve area >2 cm²)
B. Left ventricular outflow gradient <20 mmHg
C. Reduced ejection fraction (<40%)
D. Functional systolic murmur
C. Reduced ejection fraction (<40%)
Rationale: An ejection fraction below 40% reflects severe left ventricular dysfunction, a major predictor of cardiac complications such as heart failure and arrhythmias during pregnancy.
Buzzwords: Reduced ejection fraction, cardiac dysfunction, heart failure risk.
A left ventricular outflow gradient greater than which threshold is associated with increased cardiac risk during pregnancy?
A. 10 mmHg
B. 20 mmHg
C. 30 mmHg
D. 50 mmHg
C. 30 mmHg
Rationale: A left ventricular outflow gradient >30 mmHg indicates significant obstruction, increasing the risk of cardiac decompensation and complications during pregnancy.
Buzzwords: Left ventricular outflow, obstruction, cardiac decompensation.
Severe mitral valve obstruction is defined by a mitral valve area less than:
A. 1 cm²
B. 1.5 cm²
C. 2 cm²
D. 3 cm²
C. 2 cm²
Rationale: Severe mitral valve obstruction is defined by a mitral valve area <2 cm², which impairs blood flow and predisposes to pulmonary hypertension and heart failure.
Buzzwords: Severe mitral stenosis, valve obstruction, pulmonary hypertension.
Aortic valve stenosis in pregnancy is considered severe if the valve area is less than:
A. 1 cm²
B. 1.5 cm²
C. 2 cm²
D. 2.5 cm²
B. 1.5 cm²
Rationale: Aortic valve stenosis is classified as severe when the valve area is <1.5 cm², leading to increased risk of syncope, angina, and heart failure.
Buzzwords: Aortic stenosis, severe obstruction, syncope, angina.
Which condition is a significant risk factor for cardiac complications during pregnancy?
A. Cyanosis or arrhythmias
B. Ejection fraction >50%
C. Mild pulmonary valve stenosis
D. Uncomplicated mitral valve prolapse
A. Cyanosis or arrhythmias
Rationale: Cyanosis and arrhythmias are strong predictors of maternal cardiac complications such as hypoxia, arrhythmic events, or heart failure.
Buzzwords: Cyanosis, arrhythmias, cardiac complications.
What preconception counseling recommendation is most critical for women with NYHA Class III–IV heart disease?
A. Avoid physical activity during pregnancy
B. Undergo evaluation and corrective surgeries before conception
C. Continue anticoagulation therapy without adjustment
D. Schedule frequent obstetric visits post-conception
B. Undergo evaluation and corrective surgeries before conception
Rationale: Preconception evaluation and surgical correction of valve lesions or structural abnormalities improve maternal and fetal outcomes in high-risk women.
Buzzwords: Preconception counseling, corrective surgery, risk reduction.
Which maternal condition increases the risk of warfarin-related fetal anomalies during pregnancy?
A. Cyanotic congenital heart disease
B. Left ventricular dysfunction
C. Mechanical prosthetic valves
D. Ventricular septal defect
C. Mechanical prosthetic valves
Rationale: Women with mechanical heart valves require anticoagulation therapy, which carries a risk of warfarin-related fetal anomalies and maternal thromboembolism.
Buzzwords: Mechanical valves, anticoagulation, fetal anomalies.
What is the risk of inheritance for Marfan syndrome if the mother is affected?
A. 10%
B. 25%
C. 50%
D. 75%
C. 50%
Rationale: Marfan syndrome is autosomal dominant, with a 50% inheritance risk for the fetus. Aortic dilation increases maternal and fetal risks.
Buzzwords: Marfan syndrome, autosomal dominant, inheritance risk.
Congenital heart disease risk in offspring is highest for which maternal condition?
A. Pulmonary stenosis
B. Ventricular septal defect (VSD)
C. Atrial septal defect (ASD)
D. Patent foramen ovale
B. Ventricular septal defect (VSD)
Rationale: VSD has a 10–16% risk of inheritance, making it one of the most commonly inherited congenital heart defects if the mother is affected.
Buzzwords: Ventricular septal defect, congenital heart defect, inheritance risk.
Aortic stenosis increases the congenital heart disease risk in offspring by:
A. 5–10%
B. 15–18%
C. 20–25%
D. 30%
B. 15–18%
Rationale: Aortic stenosis in the mother is associated with a 15–18% risk of the fetus inheriting the condition.
Buzzwords: Aortic stenosis, congenital risk, 15–18%.
Preconception counseling for women with severe heart disease aims to:
A. Postpone pregnancy indefinitely
B. Reduce risks through corrective surgeries and risk stratification
C. Adjust anticoagulation therapy postpartum
D. Avoid physical exertion entirely during pregnancy
B. Reduce risks through corrective surgeries and risk stratification
Rationale: Corrective surgeries and comprehensive risk assessment before conception minimize complications in women with severe heart disease.
Buzzwords: Preconception counseling, risk stratification, corrective surgeries.
What is the most common fetal risk associated with maternal heart disease?
A. Premature closure of ductus arteriosus
B. Congenital heart disease
C. Intrauterine growth restriction (IUGR)
D. Oligohydramnios
B. Congenital heart disease
Rationale: The most common fetal risk in maternal heart disease is congenital heart defects, particularly in cases with a positive family history.
Buzzwords: Congenital heart disease, fetal risk, maternal heart disease.
Which congenital heart defect has a 10–16% risk of inheritance if the mother is affected?
A. Aortic stenosis
B. Pulmonary stenosis
C. Ventricular septal defect (VSD)
D. Tetralogy of Fallot
C. Ventricular septal defect (VSD)
Rationale: VSD is highly inheritable, with a 10–16% risk when the mother is affected. It poses a significant congenital risk to offspring.
Buzzwords: VSD, congenital heart defect, inheritance.
Which of the following conditions warrants avoidance of pregnancy due to high maternal risk (WHO Class 4)?
A. Mitral valve area of 2.5 cm²
B. Pulmonary arterial hypertension
C. Cyanotic congenital heart disease without repair
D. Mild left ventricular outflow obstruction
B. Pulmonary arterial hypertension
Rationale: Pulmonary arterial hypertension is a WHO Class 4 condition, contraindicating pregnancy due to high maternal mortality risk.
Buzzwords: Pulmonary hypertension, WHO Class 4, contraindicated pregnancy.
In a woman with mechanical heart valves, what is the most critical counseling point regarding pregnancy?
A. Avoid anticoagulation therapy during the first trimester
B. Continue low-dose warfarin throughout pregnancy
C. Discuss risks of fetal anomalies from warfarin exposure
D. Use aspirin as the sole anticoagulant
C. Discuss risks of fetal anomalies from warfarin exposure
Rationale: Warfarin crosses the placenta and can cause fetal anomalies, including warfarin embryopathy, necessitating pre-pregnancy counseling about anticoagulation risks.
Buzzwords: Warfarin, fetal anomalies, mechanical valves, anticoagulation risks.
