Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Domain 3 : Obstetrics > ESC Guidelines On Cardiac Diseases In Pregnancy > Flashcards

ESC Guidelines On Cardiac Diseases In Pregnancy Flashcards

1
Q

Peripartum Cardiomyopathy : Risk factors

A 
°Multiparity
°Africa Ethnicity 
°Smoking 
° Diabetes 
° Pre-eclampsia 
° Malnutrition 
° Advanced maternal age
° Teen Pregnancy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Peripartum Cardiomyopathy : causes

A

° Inflammation
° Angiogenic imbalance
They induce vascular damage.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Peripartum Cardiomyopathy : Biological factors

A

° Biological active 16 kDa prolactin, fms like tyrosine kinase
May initiate PPCM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Peripartum Cardiomyopathy : presentation

A

Heart failure 2° to LV systolic dysfunction

May present with arrhythmia and/ cardiac arrest

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Peripartum Cardiomyopathy : Diagnosis

A

Echocardiography: LVEF < 30%
MARKED LV dilatation LVEDD>6.0cm
RV Involvement associated with adverse outcomes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

PPCM: prognosis

A 
SA 12,6% affects 1:1000 15-50% morta
Germany 2.0%
Turkey 24%
If EF does not recover > 50% future pregnancy should be discouraged.
Recurrence highly possible
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Dilated Cardiomyopathy : definition

A

LV dilatation and dysfunction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Dilated Cardiomyopathy : causes

A 
Viral infection
Drugs
Ischaemia
Idiopathic 50%
Hereditary 25-35%
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Dilated Cardiomyopathy : stats

A

Prevalence of idiopathic 1:25000

SA 1:1000

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Dilated Cardiomyopathy : prognosis

A

Predictors of mortality

  • NYHA iii/iv
  • EF < 20%
  • MR
  • RV failure
  • AF
  • Hypotension
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Dilated Cardiomyopathy : Prepregnancy counselling and MX

A

Modification of antifailure RX : stop ACEI, ARBS, AR I, MRAs

Cont Blocker selective B1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Management of HF in pregnancy: acute/subacute HF

A

Pulmonary Congestion : thiazide + loop diuretic

HPT: Hydralazin, nitrates

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Management of HF in pregnancy : haemodynamicaly u stable & cardiogenic shock

A

Transfer to center with mechanical circulatory support team
Urgent delivery c/s irregardless of gestational age
Avoid Blockers especially in PPCM
Levosimendin ideal ionotrope

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Bromocriptine PPCM

A

Dose 2,5mg daily for 1/52 in uncomplicated cases
2,5mg bd 6/52 EF<25% / cardiogenic shock
Start anticoagulant LMWH/UFH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Management of HF in pregnancy : haemodynamicaly u stable & cardiogenic shock: Devices

A

Start with wearable ICD 3-6m if no recovery ICD and cardiac resynchronization devices LBBB QRS>130ms
Transplant if mechanical support not possible or no recovery 6-12m

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

HF in pregnancy : heart Transplant

A

Avoid pregnancy 1st yearconsi

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

HF in pregnancy : anticoagulant

A

Consider if low EF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

HF In pregnancy : delivery and breastfeed

A

CS if haemodynamicaly unstable

No BF if HFrEF or NYHA iii/iv

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

AHF DURING PREGNANCY flow chart

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Recommendation forx of Cardiomyopathy and HF In pregnancy

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

AHF in pregnancy MX flow chart

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Hypertrophic Cardiomyopathy in pregnancy incidence

A

<1:1000

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

HOCM in pregnancy mortality rate

A

0.5% mortality and 29% if symptomatic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

HOCM in pregnancy fetal mortality rate

A

Spontaneous abortion 15%
Therapeutic abortion 5%
Still birth 2%
Premature birth 26%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

HOCM in pregnancy mortality risk factors

A

Symptoms Prepregnancy
Diastolic dysfunction
Severe LV outflow track obstruction
Arrhythmia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

HOCM in pregnancy post partum cardiac event risk factors

A

CARPREG OR ZAHARA> 1

Medication in pregnancy period

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

HOCM in pregnancy symptoms

A

HF with pulmonary Congestion

Echo diagnostic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

HOCM in pregnancy management frequency of reviews

A

WHO I reviewed per trimester

WHO III review monthly/ bimonthly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

HOCM in pregnancy management AF

A

Rate control
Supress VA
Verapramil drug of choice when Blocker not tolarated
Cardioversion if unstable persistent AF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

HOCM in pregnancy management hypovolaemia

A

Not well tolarated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

HOCM in pregnancy management Anticoagulant

A

Therapeutic if paroxysmal or persistent arrhythmia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

HOCM in pregnancy management Sudden cardiac death

A

If symptomatic palpitations and/ syncope device insertion recommended

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

HOCM in pregnancy management Delivery

A 
C/S if LV outflow tract obstruction
No single shot spinal
Monitor BR rhythm
Oxytocin given slow infusion
IVF judiciously
34
Q

Arrhythmia in pregnancy : maternal risk

A

AF increases mortality risk
SCK ^ eisk
Congenital LQTS
Brady arrhythmia amd conduction disturbances better outcomes

35
Q

Arrhythmia in pregnancy : obs and offspring risk

A

PSVT worse outcome for both

36
Q

Arrhythmia in pregnancy : SVT

A

Adinosine drug of choice RX
BBlocker except atenolol ideal or Verapramil prevention except in WPW
Consider flecainide, propafenone(not in IHD), sotalol if 1st line drugs fail rate control

37
Q

Arrhythmia in pregnancy : AFib AFlu

A

Electrical conversation if unstable AF preceded by anticoagulant
Bitilide or flecainide if stable AF/flutter
Rate control with BBlocker
In CHD Cardioversion recommended

38
Q

Arrhythmia in pregnancy : VT

A
39
Q

Arrhythmia in pregnancy : Brady arrhythmia

A

Sinus node dysfunction : rare related to hypotensive syndrome of pregnancy supine MX lateral decubitus or pacemaker if persistent
AV block: associated with poor outcomes esp Narrow QRS complex MX ventricular pacing if symptomatic

40
Q

Arrhythmia in pregnancy intervention : electrical Cardioversion

A

Safe
Can induce fetal arrhythmia
Monitor fetal HR after conversion

41
Q

Arrhythmia in pregnancy intervention : catheter ablation

A

Postpone to 2nd tri if possible

42
Q

Arrhythmia in pregnancy intervention : ICD + pacemaker

A

Prepregnancy insertion in SCM
Radiation risk
Safety done > 8/52

43
Q

Arrhythmia surveillance recommendations

A
44
Q

Recommendation for arrhythmia in pregnancy

A
45
Q

Coronary artery disease in pregnancy : etiology

A 
Smoking
Hypertensive
Diabetes mellitus
Dyslipidemia
Thrombophilia
Advanced maternal age
Obesity
Pre-eclampsia
Postpartum infection
Cocain
PPH
Multiparity
46
Q

coronary artery disease in pregnancy : presentation

A

3rd tri

Similar presentation with none pregnancy

47
Q

Coronary artery disease in pregnancy : Diagnosis

A

Difficult ecg as in inverted t wave a normal occurrence
High troponins suggestive
Echo helpful

48
Q

Coronary artery disease in pregnancy : differentials

A

PE
Aortic dissection
Pre-eclampsia

49
Q

Coronary artery disease in pregnancy : Complications

A 
HF 38%
Arrhythmia 12%
Recurrent MIor angina 20%
Maternal Mortality 7%
Foetal death 7%
50
Q

Coronary artery disease in pregnancy : management

A

Multidisciplinary

Similar to none pregnant individuals

51
Q

Cad : intervention

A

Drug elutng Stent ideal

Asprin and P2Y12 inhibitor monitor bleeding

52
Q

Pre existing CAD

A

Mortality 0-23%

12 months post intervention

53
Q

CAD labour and delivery

A

Individuals MX
Postpone 2/52 post AMI
Vaginal delivery preferred

54
Q

AF I in pregnancy recommendation

A
55
Q

Modification WHO classification of maternal cardiovascular risk

A

I no risk
II small risk of complications
III high risk
IV pregnancy contraindicated

56
Q

Predictors maternal and Neonatal events

A
57
Q

General recommendations

A
58
Q

Risk stratification CARPREG 1

A
59
Q

CARPREG 2

A
60
Q

ZAHARA

A
61
Q

WHO classification

A
62
Q

WHO classification

A
63
Q

Obstetric consideration s

A

High risk
Planned delivery mostly vaginal
Scheduled induction

64
Q

Cardiac vaginal delivery

A

Complete Cervical dilation
No pushing
Uterus labours down
Vacuum/forceps assisted delivery

65
Q

Why no phusing?

A

Vasalva causes increased intrathoracic pressure,increase afterload, reduction in preload and overshoot of CO that occurs upon release and can predispose to acute heart failure.

66
Q

Which condition can attempt cardiac nvd?

A 
Pulmonary hypertension 
Fixed stenotic lesion
Single ventricle 
Ventricular dysfunction 
Moderate degree of aortic dilation
67
Q

Monitoring requirements for cardiac vaginal delivery

A

Pulse oximeter
5 lead ECG
A-line
No cvp/pac

68
Q

What labour analgesia can be used for cardiac vaginal delivery

A

CSE- intrathecal opioid
CSE
DURA puncture epidural

69
Q

Consideration for CSE/epidural in cardiac vaginal delivery

A

LOR saline especially shunts
Replace ineffective catheter early
No adrenaline

70
Q

Aim of labour analgesia

A

Sympathetic block avoiding increase HR BP

71
Q

Regimen

A

Bupivacaine 4-5mg Bupivacaine and fent 20-25mcg over 15-20min T6 surgical level

72
Q

RISI vs cardiac induction

A
73
Q

Additional monitoring

A

Cvp

Tee

74
Q

Pharmacological considerations oxytocin

A

Oxytocin

Prostaglandin

75
Q

Pharmacological considerations prostaglandin for alpha

A
76
Q

Pharmacological considerations ergometrine

A
77
Q

Pharmacological considerations tocolytics

A
78
Q

Pharmacological considerations antiHPT

A
79
Q

Pharmacological considerations anticoagulants mx

A
80
Q

Postpartum

A 
HC/ICU
Analgesia
Haemodynamic monitoring 
Anticoagulants reinitiation monitoring 
Multidisciplinary mx

Domain 3 : Obstetrics (30 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions