Heart Disease And Pregnancy

Question 1

Common presentations during pregnancy and postpartum (4)

Answer 1

Heart failure
Myocardial infarction
Arrhythmia
Aortic dissection

Question 2

4 key risk factors

Answer 2

Race (black higher risk)
Age older than 40
Hypertension
Obesity

(Remember, risk of heart attack)

Question 3

How does pregnancy affect BNP?

Answer 3

BNP greater than 100 and pro BNP greater than 450 Suggest heart failure and non-pregnant patients

These levels increase two fold during pregnancy and even more after delivery

Question 4

Most common arrhythmias during pregnancy

Answer 4

Premature atrial beats

Paroxysmal Superventricular tachycardia

Question 5

DDX for maternal cardiac arrest

Answer 5

Anesthetic complications
Bleeding
Cardiovascular disorders
Drugs such as magnesium sulfate
Embolism
Fever
General including metabolic and electrolyte
Hypertensive disorders including stroke

Question 6

Types of heart disease that require cesarean section

Answer 6

Marfan syndrome aortic root dilation >40 mm

Bicuspid aortic valve with aortic root dilation greater than 45 mm

Question 7

Pregnancy is contraindicated for the following cardiac anomalies

Answer 7

Pulmonary artery hypertension w ejection fraction less than 30%
Severe mitral stenosis
Severe aortic stenosis
Severe aortic dilation greater than 45 mm
Vascular ehler danlos
Fontan circulation with any complications

Question 8

Congenital heart disease

Ebstein’s anomalie

Answer 8

Apical displacement of tricuspid valve causes large right atrium and small ventricle, leading to R heart failure

Question 9

Congenital heart disease

Eisenmenger syndrome

Answer 9

Triad of:
Systemic to pulmonary communication through congenital defect (R>L shunt)
Pulmonary HTN
cyanosis

Question 10

Fontan circulation

Answer 10

Three surgeries done for hypoplastic left heart

SVC and IVC are connected to pulmonary artery and the single ventricle is used to pump blood to the body

Question 11

Tetrology of Fallot

Most common form of congenital cyanotic heart disease

Answer 11

VSD
PUlmonic stenosis
Overriding aorta
Right ventricular hypertrophy

Question 12

Transposition of great vessels

Answer 12

Pulmonary A arises from left ventricle
Aorta arises from right ventricle
Presents with cyanosis when ductus closes on first day of life

Question 13

In which types of congenital heart anomalies are oral contraceptive pills contra indicated

Answer 13

Fontan circulation
Single ventricle
Cyanotic heart dz
Pulmonary HTN 
Mechanical valves
Transposition of great vessels

Question 14

The following cardiac lesions Have no significant risk in pregnancy

Answer 14

Corrected ASD/VSD
OR ASD/VSD without pulmonary HTN
Corrected TOF
MOST valve disorders