Module 04: Cardiac Disorder During Pregnancy Flashcards
Why have cardiovascular illnesses in pregnant women decreased?
Many congenital heart defects are now corrected early in infancy, allowing individuals to live normally into adulthood.
What is one of the major causes of cardiac damage?
Rheumatic fever, though its cases have significantly decreased.
Why are cardiovascular diseases still a concern during pregnancy?
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.
How do cardiac diseases impact maternal health?
Cardiac diseases are one of the leading causes of maternal mortality.
Why does blood volume increase by more than 1L during pregnancy?
(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
What are the different
cardiovascular changes and needs during pregnancy?
(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
By how much does cardiac output increase during pregnancy?
25 to 50%
What happens to heart rate during pregnancy?
It increases to 80 to 90 bpm.
Why does iron requirement increase to 800 mg daily during pregnancy?
To support fetal growth, maternal red blood cell production, and the increased maternal blood volume.
Why is 28 to 32 weeks of gestation the most dangerous time for pregnant women with cardiac disorders?
Because blood volume is at its peak, overwhelming the heart, leading to poor oxygen and nutrient perfusion to vital organs and the fetus.
What is the 4th leading cause of maternal mortality?
Heart disease, with rheumatic heart disease being the most predominant.
Name some congenital heart defects that can affect pregnancy.
(A) Tetralogy of Fallot
(B) Atrial Septal Defect
(C) Ventricular Septal Defect
(D) Patent Ductus Arteriosus
(E) Coarctation of the Aorta
Why should pregnant women with congenital heart defects receive counseling?
Because pregnancy remains high-risk for both the mother and fetus, and there is a possibility of passing the condition to the baby.
This is a condition caused by rheumatic fever, primarily affecting the mitral valve by causing stenosis (narrowing), which reduces blood flow and cardiac output.
Rheumatic Heart Disease
Why have cases of Rheumatic Heart Disease decreased?
Due to early detection of beta-hemolytic streptococcal infections (sore throat) and the availability of Penicillin.
What is the medication used to treat Rheumatic Heart Disease?
Penicillin
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.
Marfan Syndrome
How much percent does maternal morbidity increase in Marfan Syndrome?
Five fold or Ten fold increase
Why do pregnant women with Marfan Syndrome need careful assessment?
Because of the high risk of aortic rupture, and there is a 50% chance of passing the disorder to the baby.
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)
Eisenmenger Syndrome,
Eisenmenger Syndrome usually comes from what defects?
(A) Atrial Septal Defect
(B) Ventricular Septal Defect
How does Eisenmenger Syndrome affect pregnancy outcomes?
The ability to complete pregnancy depends on the severity and classification of the heart disease.
Can women with congenital heart defects safely undergo pregnancy?
Yes, if they have surgical correction and no remaining signs of organic heart disease.
What is Class 1 heart disease during pregnancy?
Uncompromised – Cardiac disease is present, but no limitations in physical activity. No symptoms like fatigue, dyspnea, palpitations, or chest pain.
What is Class 2 heart disease during pregnancy?
Slightly compromised – Comfortable at rest, but ordinary physical activity may cause fatigue, dyspnea, palpitations, or anginal pain.
What is Class 3 heart disease during pregnancy?
Markedly compromised – Comfortable at rest, but even less than ordinary physical activity (e.g., walking a short distance) causes discomfort.
What is Class 4 heart disease during pregnancy?
Severely compromised – Cannot perform any physical activity without discomfort. Even at rest, cardiac insufficiency symptoms persist.
Why is the classification of heart disease important in pregnancy?
(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.
Why is continuous assessment important for pregnant women with cardiac defects?
To monitor exercise tolerance, symptoms like cyanosis, cough, and edema, which may indicate worsening heart failure.
Why do pregnant women with cardiac disease often experience coughing?
Due to pulmonary edema caused by heart failure.
Why is it important to assess for edema in pregnant women with heart disease?
Edema can indicate systemic heart failure, progressing from localized to generalized swelling.
What vital signs should be closely monitored in pregnant women with heart disease?
Heart rate (tachycardia), respiratory rate (tachypnea), and blood pressure, both in sitting and lying positions.
How does low maternal blood pressure affect the fetus?
It can lead to low birth weight or the baby being small for gestational age (SGA) due to poor placental blood flow.
What are key signs of cardiac decompensation in pregnancy?
(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
What happens in left-sided heart failure during pregnancy
The left ventricle fails to pump blood forward, causing back pressure, pulmonary hypertension, decreased systemic blood pressure, and low cardiac output.
How does pulmonary edema develop in left-sided heart failure?
When pulmonary pressure reaches 25 mmHg, fluid leaks into the pulmonary capillaries, causing shortness of breath and difficulty breathing.
Why do pregnant women with left-sided heart failure experience a productive cough with blood-speckled sputum?
Increased pulmonary pressure causes capillary rupture, leading to blood seeping into the alveoli, resulting in hemoptysis.
What is orthopnea, and why does it occur in left-sided heart failure?
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.
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.
Paroxysmal nocturnal dyspnea (PND)
What happens in right-sided heart failure during pregnancy?
The right ventricle becomes overloaded, causing systemic venous congestion, decreased cardiac output to the lungs, decreased aortic pressure, and increased vena cava pressure.
Why does jugular vein distention (JVD) occur in right-sided heart failure?
Back pressure prevents blood from moving forward, causing venous congestion and visible neck vein distention.
What is increased portal circulation, and how does it affect pregnant women?
Blood congestion in the portal vein leads to liver and spleen enlargement, causing discomfort and dyspnea due to diaphragm compression by the uterus.
How does hepatomegaly occur in right-sided heart failure?
Increased portal circulation causes liver congestion, leading to distention, dyspnea, and pain as the enlarged liver presses against the diaphragm.
What is splenomegaly, and why does it occur in right-sided heart failure?
Venous congestion leads to spleen enlargement, worsening systemic fluid overload.
Why does ascites occur in right-sided heart failure?
Back pressure in the venous system causes fluid leakage into the peritoneal cavity, leading to abdominal swelling.
Why does peripheral edema occur in right-sided heart failure?
Increased systemic venous pressure causes fluid retention in the lower extremities, leading to swelling.
What are the different effects of left sided heart failure on the fetus?
(A) Low birth weight
(B) Intrauterine growth restriction
(C) Abortion
(D) Stillbirth
(E) Early delivery or Preterm Birth
Can a pregnant woman with left-sided heart failure carry out her pregnancy?
Yes, but she requires medications, stress tests, and cardiovascular monitoring to prevent placental insufficiency.
Why is pregnancy not advised for women with right-sided heart failure?
Because of severe systemic congestion. If they do become pregnant, they need oxygen therapy and arterial blood gas monitoring.
What is the function of Digoxin in managing cardiac disorders during pregnancy?
Slows ventricular response and increases myocardial contractility to improve heart function.
How do Beta-Adrenergic Blockers help pregnant women with cardiac disorders?
They reduce strain on the aorta, lower blood pressure, and manage arrhythmias associated with ischemic heart disease.
Why are thiazide diuretics given to pregnant women with heart failure?
They reduce blood volume, which helps manage acute and chronic heart failure, but require potassium supplements.
What is the purpose of Aminophylline in cardiac disorder management?
It relieves bronchospasms, improving oxygenation.
Why are anticoagulants (low molecular weight heparin) given to pregnant women with heart disease?
They prevent thrombus formation, especially in patients with artificial valves or atrial fibrillation.
What is the nursing management for patients with cardiac problems?
(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).
