Heart Diseases in Pregnancy

Question 1

Cardiac output _____ during preg

Answer 1

Inc

Question 2

Overall max CO is seen during .?

Answer 2

Immediate postpartum - 70% > 2nd stage of labour > late 1st stage of labour > 28 - 32 weeks (40%)

Question 3

Vascular resistance ____ during pregnancy

Answer 3

Dec.

Question 4

BP _____ during pregnancy

Answer 4

Dec.

Question 5

BP ____ in supine position.

Answer 5

Dec.

Question 6

Supine hypotension syndrome.

Answer 6

in late 3rd trimester.
in supine position - Gravid uterus presses on IVC - Dec Venous return - dec CO - Hypotension in mother and Fetal distress .

Question 7

Heart rate and pulse rate ___ in preg.

Answer 7

Inc.

Question 8

Apex beat is heard at ___ ICS in pregnancy

Answer 8

4th instead of the normal 5th coz of diaphragm being pushed upward.

Question 9

_____ is the ECG finding in Pregnancy

Answer 9

Left axis deviation.

Question 10

S1 in preg.

Answer 10

Loud and wide +/- prominent split.

Question 11

S2 in preg.

Answer 11

normal

Question 12

S3 in preg.

Answer 12

Easily heard.

Question 13

MC murmur in Preg.

Answer 13

ejection systolic murmur. (<3/6)

Question 14

CXR finding in preg.

Answer 14

Mild cardiomegaly

Question 15

Indications of HD in pregnancy.

Answer 15

Inc JVP.
clubbing, cyanosis, PND, Orthopnea, Pul. Edema.
Ejection systolic murmur >3/6
Marked cardiomegaly on CXR
Any arrythmia.

Question 16

MC heart dis in Pregnancy

Answer 16

Mitral stenosis

Question 17

MCC of Heart dis in preg in developing countries.

Answer 17

RHD

Question 18

MC HD in pregnancy in developing countries.

Answer 18

MS

Question 19

MCC of HD in Pregnancy in developed countries

Answer 19

Congenital HD

ASD.

Question 20

MC cyanotic HD in pregnancy

Answer 20

TOF

Question 21

MC congenital valvular HD in pregnancy

Answer 21

Mitral valve prolapse.

Question 22

MC HD associated with maternal mortality.

Answer 22

Mitral stenosis.

Question 23

HD with highest risk of maternal mortality.

Answer 23

Eisenmenger syndrome

Question 24

Clark’s Classification of HD

Answer 24

Class 1 - Maternal mortality < 1 % - all congenital HD
Class 2 - 15-25%
Class 3- 25-50%

Question 25

Class 3 of clark’s classification .

Answer 25

25-50% risk of maternal mortality,
Pulmonary hypertension - primary and secondary including eisenmenger syndrome.
marfan syndrome with aortic involvement.
COA.

Question 26

HD with best prognosis for pregnancy

Answer 26

Congenital HD

Question 27

HD in which pregnancy is C/I

Answer 27

Clark’s class 3
EF <30%
Severe MS or AS.
NYHA class 3 or 4

Question 28

When to do MTP in case of HD.

Answer 28

12 weeks

Question 29

Method of MTP in case of HD

Answer 29

Suction evacuation.

Question 30

Mx of HD in labour.

Answer 30

1) Left lateral or propped up position.
2) restrict vaginal examination.
3) fluids = max 75ml / hr.
4) best mode of delivery - vaginal
if second stage of labour is prolonged > 30 mins - Prophylactic use of vacuum or forceps.

Question 31

Indications for CS in HD

Answer 31

Any aorta involvement.
Recent MI/CHF
Emergency valve replacement after delivery.
If pt has been on warfarin at labour or within 2 weeks of labour.

Question 32

Inj Methylergometrine is _____ in 3 rd stage of labour in HD

Answer 32

C/I

Question 33

laparoscopic sterilisation is _____ in pregnancy

Answer 33

C/I

Question 34

Conditions for using GA in labour.

Answer 34

Intracardiac Shunt
HOCM
Pul HTN
Severe MS or AS

Question 35

< 12 wks - Anticoagulant of choice

Answer 35

heparin.

Question 36

12-36 wks - Anticoagulant of choice

Answer 36

Warfarin.

Question 37

> 36 wks - Anticoagulant of choice

Answer 37

Heparin.

Question 38

Why is Heparin C/I after 36 weeks.

Answer 38

No antidote available.

Question 39

Warfarin can cause ____ to fetus

Answer 39

Condrodysplasia

Question 40

Surgery of choice in case of MS in Pregnancy

Answer 40

Balloon valvuloplasty

Valve replacement is C/I

Question 41

best time to do MS surgery in HD in pregnancy

Answer 41

2nd trimester - 14-18 wks.

Question 42

If pt is on warfarin at time of labour

Answer 42

Do CS