Module 04: Cardiac Disorder During Pregnancy

Question 1

Why have cardiovascular illnesses in pregnant women decreased?

Answer 1

Many congenital heart defects are now corrected early in infancy, allowing individuals to live normally into adulthood.

Question 2

What is one of the major causes of cardiac damage?

Answer 2

Rheumatic fever, though its cases have significantly decreased.

Question 2

Why are cardiovascular diseases still a concern during pregnancy?

Answer 2

Pregnant women with cardiac disorders have decreased cardiac reserve, making it harder to handle the increased workload due to pregnancy-related changes, leading to serious complications.

Question 3

How do cardiac diseases impact maternal health?

Answer 3

Cardiac diseases are one of the leading causes of maternal mortality.

Question 4

Why does blood volume increase by more than 1L during pregnancy?

Answer 4

(A) To compensate for blood loss at birth
(B) Ensure proper nutrient transport to the fetus
(C) Increase cardiac output by raising the heart rate

Question 5

What are the different
cardiovascular changes and needs during pregnancy?

Answer 5

(A) Increase blood volume more than 1L:
(B) Increase cardiac output by 25% to 50%
(C) Increase of heart rate to 80 to 90 bpm
(D) Iron needs to increase to 800 mg daily

Question 6

By how much does cardiac output increase during pregnancy?

Answer 6

25 to 50%

Question 7

What happens to heart rate during pregnancy?

Answer 7

It increases to 80 to 90 bpm.

Question 8

Why does iron requirement increase to 800 mg daily during pregnancy?

Answer 8

To support fetal growth, maternal red blood cell production, and the increased maternal blood volume.

Question 9

Why is 28 to 32 weeks of gestation the most dangerous time for pregnant women with cardiac disorders?

Answer 9

Because blood volume is at its peak, overwhelming the heart, leading to poor oxygen and nutrient perfusion to vital organs and the fetus.

Question 10

What is the 4th leading cause of maternal mortality?

Answer 10

Heart disease, with rheumatic heart disease being the most predominant.

Question 11

Name some congenital heart defects that can affect pregnancy.

Answer 11

(A) Tetralogy of Fallot
(B) Atrial Septal Defect
(C) Ventricular Septal Defect
(D) Patent Ductus Arteriosus
(E) Coarctation of the Aorta

Question 12

Why should pregnant women with congenital heart defects receive counseling?

Answer 12

Because pregnancy remains high-risk for both the mother and fetus, and there is a possibility of passing the condition to the baby.

Question 13

This is a condition caused by rheumatic fever, primarily affecting the mitral valve by causing stenosis (narrowing), which reduces blood flow and cardiac output.

Answer 13

Rheumatic Heart Disease

Question 14

Why have cases of Rheumatic Heart Disease decreased?

Answer 14

Due to early detection of beta-hemolytic streptococcal infections (sore throat) and the availability of Penicillin.

Question 15

What is the medication used to treat Rheumatic Heart Disease?

Answer 15

Penicillin

Question 16

It is an autosomal dominant disorder affecting connective tissue, leading to aortic dissection or rupture, which significantly increases the risk of maternal morbidity during pregnancy.

Answer 16

Marfan Syndrome

Question 17

How much percent does maternal morbidity increase in Marfan Syndrome?

Answer 17

Five fold or Ten fold increase

Question 18

Why do pregnant women with Marfan Syndrome need careful assessment?

Answer 18

Because of the high risk of aortic rupture, and there is a 50% chance of passing the disorder to the baby.

Question 19

A condition that leads to pulmonary hypertension due to left-to-right shunting in the heart caused by untreated congenital heart defects (e.g., ASD, VSD)

Answer 19

Eisenmenger Syndrome,

Question 20

Eisenmenger Syndrome usually comes from what defects?

Answer 20

(A) Atrial Septal Defect
(B) Ventricular Septal Defect

Question 21

How does Eisenmenger Syndrome affect pregnancy outcomes?

Answer 21

The ability to complete pregnancy depends on the severity and classification of the heart disease.

Question 22

Can women with congenital heart defects safely undergo pregnancy?

Answer 22

Yes, if they have surgical correction and no remaining signs of organic heart disease.

Question 23

What is Class 1 heart disease during pregnancy?

Answer 23

Uncompromised – Cardiac disease is present, but no limitations in physical activity. No symptoms like fatigue, dyspnea, palpitations, or chest pain.

Question 24

What is Class 2 heart disease during pregnancy?

Answer 24

Slightly compromised – Comfortable at rest, but ordinary physical activity may cause fatigue, dyspnea, palpitations, or anginal pain.

Question 25

What is Class 3 heart disease during pregnancy?

Answer 25

Markedly compromised – Comfortable at rest, but even less than ordinary physical activity (e.g., walking a short distance) causes discomfort.

Question 26

What is Class 4 heart disease during pregnancy?

Answer 26

Severely compromised – Cannot perform any physical activity without discomfort. Even at rest, cardiac insufficiency symptoms persist.

Question 27

Why is the classification of heart disease important in pregnancy?

Answer 27

(A) Class 1 & 2 – Can have a normal pregnancy and birth. (B) Class 3 – Can complete pregnancy with special interventions (e.g., bed rest). (C) Class 4 – Advised to avoid pregnancy due to high risk of cardiac failure.

Question 28

Why is continuous assessment important for pregnant women with cardiac defects?

Answer 28

To monitor exercise tolerance, symptoms like cyanosis, cough, and edema, which may indicate worsening heart failure.

Question 29

Why do pregnant women with cardiac disease often experience coughing?

Answer 29

Due to pulmonary edema caused by heart failure.

Question 30

Why is it important to assess for edema in pregnant women with heart disease?

Answer 30

Edema can indicate systemic heart failure, progressing from localized to generalized swelling.

Question 31

What vital signs should be closely monitored in pregnant women with heart disease?

Answer 31

Heart rate (tachycardia), respiratory rate (tachypnea), and blood pressure, both in sitting and lying positions.

Question 32

How does low maternal blood pressure affect the fetus?

Answer 32

It can lead to low birth weight or the baby being small for gestational age (SGA) due to poor placental blood flow.

Question 33

What are key signs of cardiac decompensation in pregnancy?

Answer 33

(A) Fatigue (B) Tachycardia (C) Poor fetal heart tones (D) Decreased amniotic fluid from IUGR (E) Cough (F) Tachypnea (G) Edema from poor venous return

Question 34

What happens in left-sided heart failure during pregnancy

Answer 34

The left ventricle fails to pump blood forward, causing back pressure, pulmonary hypertension, decreased systemic blood pressure, and low cardiac output.

Question 35

How does pulmonary edema develop in left-sided heart failure?

Answer 35

When pulmonary pressure reaches 25 mmHg, fluid leaks into the pulmonary capillaries, causing shortness of breath and difficulty breathing.

Question 36

Why do pregnant women with left-sided heart failure experience a productive cough with blood-speckled sputum?

Answer 36

Increased pulmonary pressure causes capillary rupture, leading to blood seeping into the alveoli, resulting in hemoptysis.

Question 37

What is orthopnea, and why does it occur in left-sided heart failure?

Answer 37

Difficulty breathing while lying flat, due to worsening pulmonary edema. Keeping the head and chest elevated helps fluid settle at the lung base, improving gas exchange.

Question 38

This condition is known as the sudden nighttime shortness of breath due to fluid shifting back into circulation, increasing left-sided heart failure and pulmonary edema.

Answer 38

Paroxysmal nocturnal dyspnea (PND)

Question 39

What happens in right-sided heart failure during pregnancy?

Answer 39

The right ventricle becomes overloaded, causing systemic venous congestion, decreased cardiac output to the lungs, decreased aortic pressure, and increased vena cava pressure.

Question 40

Why does jugular vein distention (JVD) occur in right-sided heart failure?

Answer 40

Back pressure prevents blood from moving forward, causing venous congestion and visible neck vein distention.

Question 41

What is increased portal circulation, and how does it affect pregnant women?

Answer 41

Blood congestion in the portal vein leads to liver and spleen enlargement, causing discomfort and dyspnea due to diaphragm compression by the uterus.

Question 42

How does hepatomegaly occur in right-sided heart failure?

Answer 42

Increased portal circulation causes liver congestion, leading to distention, dyspnea, and pain as the enlarged liver presses against the diaphragm.

Question 43

What is splenomegaly, and why does it occur in right-sided heart failure?

Answer 43

Venous congestion leads to spleen enlargement, worsening systemic fluid overload.

Question 44

Why does ascites occur in right-sided heart failure?

Answer 44

Back pressure in the venous system causes fluid leakage into the peritoneal cavity, leading to abdominal swelling.

Question 45

Why does peripheral edema occur in right-sided heart failure?

Answer 45

Increased systemic venous pressure causes fluid retention in the lower extremities, leading to swelling.

Question 46

What are the different effects of left sided heart failure on the fetus?

Answer 46

(A) Low birth weight (B) Intrauterine growth restriction (C) Abortion (D) Stillbirth (E) Early delivery or Preterm Birth

Question 47

Can a pregnant woman with left-sided heart failure carry out her pregnancy?

Answer 47

Yes, but she requires medications, stress tests, and cardiovascular monitoring to prevent placental insufficiency.

Question 48

Why is pregnancy not advised for women with right-sided heart failure?

Answer 48

Because of severe systemic congestion. If they do become pregnant, they need oxygen therapy and arterial blood gas monitoring.

Question 49

What is the function of Digoxin in managing cardiac disorders during pregnancy?

Answer 49

Slows ventricular response and increases myocardial contractility to improve heart function.

Question 50

How do Beta-Adrenergic Blockers help pregnant women with cardiac disorders?

Answer 50

They reduce strain on the aorta, lower blood pressure, and manage arrhythmias associated with ischemic heart disease.

Question 51

Why are thiazide diuretics given to pregnant women with heart failure?

Answer 51

They reduce blood volume, which helps manage acute and chronic heart failure, but require potassium supplements.

Question 52

What is the purpose of Aminophylline in cardiac disorder management?

Answer 52

It relieves bronchospasms, improving oxygenation.

Question 53

Why are anticoagulants (low molecular weight heparin) given to pregnant women with heart disease?

Answer 53

They prevent thrombus formation, especially in patients with artificial valves or atrial fibrillation.

Question 54

What is the nursing management for patients with cardiac problems?

Answer 54

(A) Encourage rest periods (Lay in left lateral position to preserve cardiac reserve) (B) Promote healthy nutrition (High in iron and high in protein and low in sodium) (C) Emphasize the importance of taking medications religiously (D) Educate on avoiding infection (infection will increase temperature which will force the woman to expand in energy; thus increasing metabolism and increasing cardiac output). (E) Be prepared for emergency actions (Have prenatal visits every 2 weeks in the first trimester, and every week in the second trimester).