Heart Disease Flashcards
What is the commonest indirect cause of maternal mortality
Heart disease & RTA
What is the commonst cause of maternal mortality (Direct)
Ectopic, hemorrhage, pre-eclampsia and eclampsia
What are the commenst heart diseases during the reproductive age?
Coronary artery, conginital, and rheumatic heart disease
Why is hypertension,diabetes and obesity are Common during pregnancy?
Because women are getting pregnant in their late 30s
Why are females less likely to develop CAD?
Effect of estrogen
Why is Rh heart disease more common in saudi
Infections and reluctance to use Ab
When does the cardiac output during preg increase and when is the peak?
In the 1st trimester, peaks in 32 (30-50%)
What is the normal CO in females and males (not pregnant)
5L
What is the CO by 32 weeks (approximate)
4L > 6L
What are the causes for increased CO?
- early preg: increase SV
- late preg: increase HR
- decreased (peripheral resistance\viscosity)
Why is there decreased blood viscosity?
To maintan BP from increasing (causes hypotension)
How does physiological anemia usually develop?
- relative increase in plasma volume
- increase in RBC mass
> > decrease in viscosity
How is the physiological anemia (increased plasma and decreased RBC volume) a protective factor?
1- Because if there’s bleeding, then the blood lost will be mostly diluted
2- to increase the O2 carrying capacity
3- decrease thrombosis
What are the classes and grading of functional capacity of the heart?
1: No limit - sx w\extra activity
2: mild limit - sx w\ordianry acitvity
3: marked limit - sx w\less ordinary
4: severe limit - sx w\rest
What are the clinical features in normal pregnancy that can mimic cardiac disease
1- dyspnea 2- pedal edema 3- cardiac impulse (Displaced apex) 4- JV distension 5- ESM in left sternal boarder
Why is dyspnea present in normal pregnancy?
Hyperventilation due to elevated diaphragm
What are cardiac impulses usually seen in normal pregnancy
Diffused, shifted laterally from the elevated diaphragm
Why is ESM commonly heard in pregnancy
Increased flow through aortic and pulmonary valves
What do you expect to see in the ECG of pregnant women (That could be misleading but are normal)
Ectopics, Qwave, inveted T wave, ST depression, QRS left shift
What do you expect to see in the CXR of pregnant women (That could be misleading but are normal)
Increased vascular markings & slight cardiomegaly
What are the criteria to diagnose a cardiac disease during pregnancy
1- diastolic murmurs
2- severe systolic murmurs (grade 3)
3- unequivocal enlargment of heart On CXR
4- severe arrythemia, Afib or flutter
What are the signs and symptoms indicating heart disease
Dyspnea, orthpnra, PND, Hemoptysis, syncope, chest pain, cyanosis, clubbing, presistant vein distension, loud diastolic murmus, cardiomargaly and arrythmia
Name low risk cardiac lesions of maternal mortality
1- septal defect
2- Class 1 and 2 NYHA
3- PDA
4- pulmonary and tricuspid lesions
Name moderate risk cardiac lesions of maternal mortality
1- NYHA class 3 and 4 2- aortic stenosis 3- marfan’s syndrome With normal aorta 4- uncomplicated COA 5- past hx of MI
Name high risk cardiac lesions of maternal mortality
1- Essenmenger
2- PHTN
3- marfan syndrom with abnormal aortic root
4- peripartum cardiomyopathy
What are the killers of heart disease during pregnancy?
CHF, subacute bacterial endocarditis, thromboembolic disease
What are the cardiac conditions that are non debatable to terminate pregnancy
Pulmonary HTN, essinmengr, cyanotic heart disease, LVEF, prev MI, marfan syndrome with abnomral aortic root >4cm
What are the risk factor for cardiac disease during preg
Anemia, infection, obesity &HTN, hyperTSH, multiple pregnancy
How to reduce the risk for cardiaca disease during pregnancy
Look for infections & treat as early, give iron, advise weight loss, control HTN, avoid ovulation induction, insure adquate dental care
Why is it important to assess the dental care during ANC?
High risk of developing preterm labor and bacterial endocarditis
What are the hemodynamics during labor?
1- increase of CO 50% in 2nd stage
2- increase in venous return “sudden”
3- continues auto-transfusion up to 24\72hrs with high risk of pulmonary edema
What is the mode of delivery in heart diseases
NVD preferred, in obstetric cases CS, and high risk patients insure centers with ICU services
What are the intra-partum care for patients with cardiac diesase
- specialist hospital
- fluids, oxygen, analgesia, syntocinon
- lateral position if symptomatic
- shortened 2nd stages
What are prophylaxis for SABE?
- Ab prophylaxis of 2gm ampicillin IV
++++ 1.5mg per kg gentamycin IV
Prior to proceudre followed by one or more ampicllin 8 hours later
What if the patient has penicillin allergy
Give vancomycin IV
What to do if the patient is at risk for thromobembolism
Calculate the risk in first, second and third trimester
Give low molecular weight heparin and warfarin give it post partum
Why does warfarin not indicated in the first 3 months of pregnancy
Teratogenic effect
Why does warfarin not indicated in the last 3 months of pregnancy
May cause preterm labor
What is the best option for contraception in patient with cardiac diseases?
Progestin pills or long acting injectable progesterone
Or
Best: sterilization tubal ligation and vasectomy
Why are other methods of contraception not indicated
- OCP: thromboembolism
- IUCD: infective endocarditis
- barrier: not effective
