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Gyne > Heart Disease > Flashcards

Heart Disease Flashcards

1
Q

What is the commonest indirect cause of maternal mortality

A

Heart disease & RTA

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2
Q

What is the commonst cause of maternal mortality (Direct)

A

Ectopic, hemorrhage, pre-eclampsia and eclampsia

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3
Q

What are the commenst heart diseases during the reproductive age?

A

Coronary artery, conginital, and rheumatic heart disease

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4
Q

Why is hypertension,diabetes and obesity are Common during pregnancy?

A

Because women are getting pregnant in their late 30s

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5
Q

Why are females less likely to develop CAD?

A

Effect of estrogen

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6
Q

Why is Rh heart disease more common in saudi

A

Infections and reluctance to use Ab

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7
Q

When does the cardiac output during preg increase and when is the peak?

A

In the 1st trimester, peaks in 32 (30-50%)

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8
Q

What is the normal CO in females and males (not pregnant)

A

5L

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9
Q

What is the CO by 32 weeks (approximate)

A

4L > 6L

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10
Q

What are the causes for increased CO?

A
  • early preg: increase SV
  • late preg: increase HR
  • decreased (peripheral resistance\viscosity)
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11
Q

Why is there decreased blood viscosity?

A

To maintan BP from increasing (causes hypotension)

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12
Q

How does physiological anemia usually develop?

A
  • relative increase in plasma volume
  • increase in RBC mass

> > decrease in viscosity

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13
Q

How is the physiological anemia (increased plasma and decreased RBC volume) a protective factor?

A

1- Because if there’s bleeding, then the blood lost will be mostly diluted
2- to increase the O2 carrying capacity
3- decrease thrombosis

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14
Q

What are the classes and grading of functional capacity of the heart?

A

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

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15
Q

What are the clinical features in normal pregnancy that can mimic cardiac disease

A 
1- dyspnea 
2- pedal edema 
3- cardiac impulse (Displaced apex) 
4- JV distension 
5- ESM in left sternal boarder
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16
Q

Why is dyspnea present in normal pregnancy?

A

Hyperventilation due to elevated diaphragm

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17
Q

What are cardiac impulses usually seen in normal pregnancy

A

Diffused, shifted laterally from the elevated diaphragm

18
Q

Why is ESM commonly heard in pregnancy

A

Increased flow through aortic and pulmonary valves

19
Q

What do you expect to see in the ECG of pregnant women (That could be misleading but are normal)

A

Ectopics, Qwave, inveted T wave, ST depression, QRS left shift

20
Q

What do you expect to see in the CXR of pregnant women (That could be misleading but are normal)

A

Increased vascular markings & slight cardiomegaly

21
Q

What are the criteria to diagnose a cardiac disease during pregnancy

A

1- diastolic murmurs
2- severe systolic murmurs (grade 3)
3- unequivocal enlargment of heart On CXR
4- severe arrythemia, Afib or flutter

22
Q

What are the signs and symptoms indicating heart disease

A

Dyspnea, orthpnra, PND, Hemoptysis, syncope, chest pain, cyanosis, clubbing, presistant vein distension, loud diastolic murmus, cardiomargaly and arrythmia

23
Q

Name low risk cardiac lesions of maternal mortality

A

1- septal defect
2- Class 1 and 2 NYHA
3- PDA
4- pulmonary and tricuspid lesions

24
Q

Name moderate risk cardiac lesions of maternal mortality

A 
1- NYHA class 3 and 4
2- aortic stenosis 
3- marfan’s syndrome With normal aorta 
4- uncomplicated COA 
5- past hx of MI
25
Q

Name high risk cardiac lesions of maternal mortality

A

1- Essenmenger
2- PHTN
3- marfan syndrom with abnormal aortic root
4- peripartum cardiomyopathy

26
Q

What are the killers of heart disease during pregnancy?

A

CHF, subacute bacterial endocarditis, thromboembolic disease

27
Q

What are the cardiac conditions that are non debatable to terminate pregnancy

A

Pulmonary HTN, essinmengr, cyanotic heart disease, LVEF, prev MI, marfan syndrome with abnomral aortic root >4cm

28
Q

What are the risk factor for cardiac disease during preg

A

Anemia, infection, obesity &HTN, hyperTSH, multiple pregnancy

29
Q

How to reduce the risk for cardiaca disease during pregnancy

A

Look for infections & treat as early, give iron, advise weight loss, control HTN, avoid ovulation induction, insure adquate dental care

30
Q

Why is it important to assess the dental care during ANC?

A

High risk of developing preterm labor and bacterial endocarditis

31
Q

What are the hemodynamics during labor?

A

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

32
Q

What is the mode of delivery in heart diseases

A

NVD preferred, in obstetric cases CS, and high risk patients insure centers with ICU services

33
Q

What are the intra-partum care for patients with cardiac diesase

A
  • specialist hospital
  • fluids, oxygen, analgesia, syntocinon
  • lateral position if symptomatic
  • shortened 2nd stages
34
Q

What are prophylaxis for SABE?

A
  • Ab prophylaxis of 2gm ampicillin IV
    ++++ 1.5mg per kg gentamycin IV
    Prior to proceudre followed by one or more ampicllin 8 hours later
35
Q

What if the patient has penicillin allergy

A

Give vancomycin IV

36
Q

What to do if the patient is at risk for thromobembolism

A

Calculate the risk in first, second and third trimester

Give low molecular weight heparin and warfarin give it post partum

37
Q

Why does warfarin not indicated in the first 3 months of pregnancy

A

Teratogenic effect

38
Q

Why does warfarin not indicated in the last 3 months of pregnancy

A

May cause preterm labor

39
Q

What is the best option for contraception in patient with cardiac diseases?

A

Progestin pills or long acting injectable progesterone

Or

Best: sterilization tubal ligation and vasectomy

40
Q

Why are other methods of contraception not indicated

A
  • OCP: thromboembolism
  • IUCD: infective endocarditis
  • barrier: not effective

Gyne (18 decks)

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