Maternal cardiac

Question 1

Maternal Physiology (increases or decreases?):
Cardiac output 
Heart rate
LV stroke volume
Systemic vascular resistance
Pulmonary vascular resistance
Mean arterial pressure
Colloid osmotic pressure

Answer 1

Cardiac output  + 43%
Heart rate + 17%
LV stroke volume + 17%
Systemic vascular resistance -21%
Pulmonary vascular resistance -34%
Mean arterial pressure +4%
Colloid osmotic pressure -14%

Question 2

Risk for severe cardiac dysfunction in pregnancy? (3)

Answer 2

1) Prior to mid pregnancy
2) After 28 weeks
3) Labour/delivery/PP

Question 3

When does cardiac output (+43%) increase in pregnancy?

Answer 3

1) 8 weeks (by 50%)

2) max at mid-pregnancy

Question 4

What are normal cardiac symptoms and signs in pregnancy? (4)

Answer 4

1) Lower extremity edema
2) respiratory effort accentuated
3) Systolic murmur (mammary souffle)
4) Decrease in exercise tolerance

Question 5

Symptoms suggestive of undiagnosed cardiac disease in pregnancy? (5)

Answer 5

1) Syncope
2) Chest pain
3) Nocturnal cough
4) Orthopnea/progressive dyspnea
5) hemoptysis

Question 6

Signs suggestive of undiagnosed cardiac disease in pregnancy?

Answer 6

1) Diastolic murmur
2) systolic ejection murmur 3/6 or greater
3) Persistent distended neck vein
4) Persistent split second heart sound
5) cyanosis
6) clubbing
7) pulmonary hypertension
8) cardiomegaly
9) arrhythmia

Question 7

In pregnancy, what are normal findings?
ECG
CXR
ECHO

Answer 7

ECG
ST changes in inferior leads
Left axis deviation
PAC, PVC

CXR:
mild cardiac silhouette widening

Echo:
Tricuspid regurgitation

Question 8

NYHA Heard disease classification
Class I
Class II
Class III
Class IV

Answer 8

Class I–>no physical limitations
Class II–> symptoms with exercise and ordinary activities (walking, climbing stairs); no symptoms at rest
Class III–> symptoms with less than ordinary activities (dressing, washing); no symptoms at rest
Class IV–> symptoms with all physical activity

Question 9

Risk of pulmonary edema, stroke, cardiac arrest or death if one or more of these risk factors (4)

Answer 9

1) NYHA class III or IV
2) EF <40%
3) prior TIA, CHF, arrhythmia, or stroke
4) Left sided obstruction (Mitral valve < 2 cm2; Aortic valve < 1.5 cm2)

Question 10

Mortality Risk <1% (5)

Answer 10

1) PDA
2) VSD
3) ASD
4) Corrected TOF
5) Mitral stenosis NYHA Class I, II

Question 11

Mortality Risk 5-15% (9)

Answer 11

1) Uncorrected TOF
2) AS
3) MS with NYHA class III or IV
4) EF
5) previous MI
6) Marfan, normal aorta
7) coartation
8) artificial valve
9) MS with A. fib

Question 12

Mortality Risk 25-50%

Answer 12

1) pulmonary HTN
2) Eisenmengers
3) Marfan syndrome with aortic involvement
4) previous peripartum cardiomyopathy with any residual impairment of L ventricular dysfunction

Question 13

Vaginal delivery is typically preferred in cardiac patients except in these following circumstances: (6)

Answer 13

1) Marfan’s syndrome aortic root >4.0 cm or aortic aneurysm
2) Acute severe CHF (can used medical therapy)
3) Recent MI
4) need for emergency valve replacement immediately after delivery
5) warfarin administration within 2 weeks (can use vitamin K)
6) severe symptomatic aortic stenosis