Heart disease in OB

Question 1

Heart conditions with high mortality in OB

Answer 1

NYHA III (limited activity with normal activity) / IV (Sx at rest), Pulm HTN, Eisenmenger, Marfan’s

Question 2

Rheumatic Heart Disease: cause, result

Answer 2

Acute Rheumatic Fever after Strept A infection

Can lead to Mitral Stenosis

Question 3

Mitral Valve Stenosis: size and result

Answer 3

Normal > 4 cm2
Severe < 1 cm2

When severe, increased LA pressures leading to pulm edema and pulm HTN, dyspnea, a fib

Question 4

Mitral Valve Stenosis in pregnancy, and treatment

Answer 4

Can worsen NYHA class
Beta block to slow heart rate and increase diastolic filling time
Treat Afib/flutter aggressively (beta block, digoxin, cardioversion)
Avoid hypovolemia
Avoid low SVR states
Avoid increases in PVR

If non-emergent, epidural with slow dosing and good loading is good

If emergent, GA, as spinal without load will make things worse (low SVR, tachycardia)