Medical Surgical Disorders Flashcards
How does the state of pregnancy affect blood volume?
What sort of offsets the volume change though?
Blood volume will increase 30-50% which increases the workload of the heart
The mom’s vessels will dilate in order to offset increased blood volume
What does state of pregnancy do to HR?
How does this affect CO?
Increase HR which causes increased CO cardiac output
How does pregnancy affect fluid?
How does pregnancy affect weight?
Pregnancy can cause in an increase of edema from fluid but this should be below the knees. If it is higher , than this could be an issue with something else going on.
Well we are expecting there to be weight gain from pregnancy due to the fetus but also fluid and fat stores.
What happens if a mom isn’t able to adapt to her weight gain phsyiolgoically?
Normal woman adapt but if not, secondary issues of the heart can arise. They can have congestive heart failure around the 25-30 week mark. You’ll see the symptoms pop up too.
Diagnosing heart disease steps/progression
History
Physical Exam
Testing
Severity
What is mom’s functional capacity? Depending on the severity of condition, it can be affected.
Degree of disability
More important and dictates her management even more so than her classification.
How many classifications of heart disease are there?
How do they work?
4 classes
The classes of heart disease can progress as pregnancy progresses or symptoms worsen
Class 1 heart disease
No signs or symptoms in majority of pregnancy. - however just so you know , mom's who don't have signs can easily develop them at the 28-30 weeks gestation to where she progresses to a higher class of heart disease
Class 2 heart disease
Sx of heart issues that limit their activity only slightly
- after exertion maybe running up stairs
Class 3 of heart disease
Sx of heart issue but now the limitations of activity are marked
- after just walking across the room
Class 4 of heart disease
Sx of heart issue but now while just resting
What percent of pregnant women are affected by cardiac disorders?
What is surveillance gonna be like for these women when they’re pregnant?
Cardiac only affects 1% of pregnancies
Mom will have more ongoing assessments so you’ll have to warn her she will be coming in a lot
What percent of cardiac issues in pregnant women were from congenital heart lesions or they were born with the heart issue?
Examples?
50% of the cases were from congenital born defects
ASD, VSD etc
If you see a women with pulmonary hypertension, what is a reason this could be?
Weight loss drugs or other drugs that causes her vessels to constrict and cause the hypertension
What is MVP? And how can pregnancy affect it?
Mitral Valve prolapse
Pregnancy sometimes can make the mitral valve prolapse symptoms scale back a bit but others can exacerbations , awareness of heart beating, soa
What is a dropping category of heart disease in pregnancy?
What if happens to the heart if someone gets is and is affected by this?
Rheumatic heart disease because we have antibiotics for Group A Strep and we screen for it aggressively
Mitral valve stenosis occurs due to it
What is Peripartum Cardiomyopathy?
Affects the myocardium (muscle) to the point their left ventricle is dysfunctional despite no previous heart issue
When does Peripartum Cardiomyopathy occur?
In pregnant woman - occurs in last month of pregnancy or up to 5 months after the delivery of the baby
- usually 2-3 weeks within delivery though
Peripartum Cardiomyopathy cause?
Peripartum Cardiomyopathy symptoms?
Unknown
Symptoms of congestive heart failure with cardiomyopathy
- onset of dyspnea
- SOB
- tired
- low edema
- heart enlargement
No heart issue. Gets pregnant. Delivers. 2-3 weeks later you’ll see heart symptoms.
Diagnosis is based off of for Peripartum Cardiomyopathy?
The onset description with symptoms and diagnostic tests like echo or EKG
Medicine Treatment for Peripartum Cardiomyopathy?
Management?
Digoxin
Diuretics
Vasodilators
Anti-coagulant to decrease clots
Reduce sodium and fluid
Put on bedrest
What are the odds Peripartum Cardiomyopathy resolves?
Chance it’ll happen again in another pregnancy?
Chance of death from Peripartum Cardiomyopathy?
50% chance of resolution with 6 months Peripartum Cardiomyopathy
20-50% chance of it happening again
85% chance of death if it doesn’t get resolved from a secondary diagnosis so not a great prognosis
When managing pregnancy in a patient with cardiovascular issues going on, what is the goal?
What tips do we give for this?
(supplementation, health, bathroom)
Minimize the stress for them for their heart’s sake
We want them to take all their vitamins. Fe, prenatal, and folic acid
Avoid infections if they can help it and treat asap if they get on
No straining on toilet so use stool softeners
What diet should you instruct mom’s with heart disease to eat for prenatal management? Activity levels for mom?
Low sodium , High iron, High protein
Activity tolerance may be less so less activity which explain decreased calories
Also make sure she has a consult with dietician to make sure she is eating the right things
- and this prenatal stuff means she should be eating like this anyways !!
Pregnancy is a ________ state so they develop clots easier.
What 3 meds do moms with heart issues receive to address this?
What meds will they avoid?
For moms who are hypercoaguable (any mom with heart disease in pregnancy), what should you mention about their diet in relation to meds?
Hypercoaguable state so more clots
Put mom on heparin or Lovenox to SQ since they are easy and inexpensive and can be self administered
Can be put on Aspirin as well but it is weaned off before delivery
Avoid Warfarin for the first trimester
Eat consistently when it comes to green, leafy foods due to Vit K , so they don’t counter act their medicine
How many hours of do women with heart issues need ?
At least 10 hours of sleep and naps