MODULE 6: Cardiac Disorder during Pregnancy Flashcards
Major cause of Cardiac Damage
Rheumatic Fever
Significant cardiovascular changes and needs during pregnancy
a. Increase of blood volume to more than 1L
b. Increase of cardiac output to 25 - 50 %
c. Increase heart rate to 80 - 90 bpm
d. Iron needs increases to 800 mg daily
Increase of blood volume to more than 1L
a. Leads to increased cardiac output and heart rate
b. 28 - 32 weeks blood volume is at its peak / maximum amount
Iron needs increases to 800 mg daily
a. For fetal growth
b. To cater maternal and red blood cells
Cardiac Disorders
a. Congenital heart defects
b. Rheumatic heart disease
c. Marfan Syndrome
d. Eisenmenger syndrome
Congenital Heart Defects
a. teratology of allot
b. atrial and septal defect
c. ventricular septal defect
d. Patent ductus arteriosus
e. coarctation of the aorta
Congenital Heart Defects management
Requires counsel since there is still a risk for the mother and fetus
An example of Rheumatic heart disease
Mitral Valve stenosis
Mitral valve stenosis
a. Prompt identification of pharyngeal infection caused by beta - hemolytic streptococcus infection
b. Most common lesion is in mitral valve in rheumatic heart disease
c. Penicillin is used as medication managemen
Marfan Syndrome
a. Dissection / rupture of the aorta
b. Autosomal dominant disorder
c. Requires counseling and cardiovascular assessment
d. 50% chance to be passed to offsprings
Eisenmenger syndome
a. Left to right shunting (atrial septal defect, ventricular septal defect)
b. Development of pulmonary hypertension
Classification of Heart Disease
a. Class 1 Uncompromised
b. Class 2 Slightly Compromised
c. Class 3 Markedly Compromised
d. Class 4 Severely Compromised
Class I Uncompromised
a. Has cardiac disease but they don’t have limitation
b. No symptoms of cardiac insufficiency ; fatigue, chest pain, palpitation
c. Can experience normal pregnancy at birth
Class III Markedly Compromised
A. Has cardiac disease with marked limitation of physical activity
B. Comfortable at rest
C. Less than ordinary physical activity can experience fatigue when walking , shortness of breath, palpitations, chest pain
D. Can complete pregnancy by bed rest
b. Class II Slightly Compromised
a. Has cardiac disease but they have slight limitation
b. Comfortable at rest
c. Physical activity can lead to fatigue, shortness of breath, palpitations, chest pain
d. Can experience normal pregnancy at birth
CLASS IV Severely compromised
A. Has cardiac disease that can lead to inability of patient to carry on any physical activity even without experience, discomfort or at rest
B. Can experience normal pregnancy at birth
C. Can complete pregnancy by bed rest
d. Advised to prevent pregnancy since they are in cardiac failure even at rest
Assessment
a. Fatigue
b. Tachycardia
c. Poor fetal heart tone
d. Decreased amniotic fluid from IUGR
e. Cough
f. Tachypnea
g. Document patient’s activity level before asking problems current or history
Cough
Due to pulmonary edema from heart failure
Effects of Cardiac Disorders to Mother
a. left side heart failure
b. right side heart failure
Left sides heart failure
a. Become distended due to back pressure which leads to pulmonary hypertension
b. Pulmonary edema
c. Productive cough with blood speckled sputum (hemoptysis)
d. Orthopnea
e. Paroxysmal nocturnal dyspnea
Pulmonary edema
Caused by fluid passing from pulmonary capillary membranes into capillaries
Orthopnea
Orthopneic position (chest and head is elevated for fluid to settle in lungs)
Right side heart failure
a. Back pressure leads to distended jugular vein
b. Distended jugular vein
c. Increased portal circulation
d. Hepatomegaly
e. Splenomegaly
f. Dyspnea
g. Pain
h. Ascites
i. Peripheral edema
Hepatomegaly
Pressed upward against diaphragm
Dyspnea
Due to enlarged liver
Effects of Cardiac Disorders to Fetus
a. left side heart failure
b. right side heart failure
Ascites
Excruciate fluid from blood vessels will sit out in peritoneal cavity
Left side heart failure
a. Low birth weight
b. Intrauterine growth restriction
c. Abortion
d. Still birth
e. Early delivery / preterm birth
Low birth weight
Due to inadequate nutrients
Intrauterine growth restriction
In result for small gestational age
Abortion
Due to poor placental perfusion
Right side heart failure
a. Anomalies are not corrected
b. women not advised to get pregnant
c. Requires oxygen administration
d. Arterial gas monitoring
e. Hospitalized for some days especially in last days of pregnancy
Medical Management
a. Digoxin
b. Diuretics
c. Beta Adrenergic blockers (Propranolol)
d. Aminophyllin
e. Anticoagulants (low molecular weight heparin)
Digoxin
To slow the ventricular response and to increase myocardial contractility
Diuretics
a. To reduce blood volume
b. For acute and chronic heart failure with prolonged potassium supplements
c. Thiazide and furosemide
Beta Adrenergic Blockers (Propanolol)
a. To decrease the strain of the aorta and decrease blood pressure
b. For arrhythmia associated with ischaemic heart disease
Aminophylline
Helps relieves bronchospasm
Anticoagulants (low molecular weight heparin)
a. To prevent thrombus formation
b. For patients with artificial valves or atrial fibrillation
c. It crosses placenta but it is not indicated to have teratogenic effects
Nursing Managent
a. Encourage rest periods
b. Promote healthy nutrition
c. Emphasize importance of taking medications religiously
d. Educate on avoiding infection
e. Be prepared for emergency actions
Encourage rest periods includes
a. 2 rest periods a day
b. 8 -10 hours of sleep per day
c. Lay on left lateral position
Nursing Diagnosis
a. Decreased cardiac output
b. Impaired gas exchange related to pulmonary edema
c. Fear related to possible effects of maternal cardiac condition and fetal well being
d. Deficient knowledge related to care after pregnancy
Promoting healthy nutrition includes
High in iron, protein, low in sodium for fetal development
