Pregnancy

Question 1

Risk factors for CVD

Answer 1

Age > 40
Black
HTN
Obesity

Question 2

Normal pregnancy hemodynamics

Answer 2

Increase in HR
Increased CO
Decreased SVR, PVR
Little change in BP

Question 3

Labor and delivery hemodynamics

Answer 3

Increased CO (HR and BP)
Increased blood volume, venous return
Volume loss at delivery

Question 4

Advise against pregnancy

Answer 4

PAH
EF < 30
Previous peripatrum CM with residual LV dysfunction
Severe MS, severe symptomatic AS, severe coarctation, severe aortic dilatation
Vascular ehlers-danlos
Fontan with complications

Question 5

Treat HTN if

Answer 5

SBP >= 150

DBP >= 95

Question 6

Warfarin for mechanical prosthesis

Answer 6

Increased fetal complications, lower risk for mother

Less risk if <= 5 mg daily, preferred in 1st and 2nd trimester

Question 7

Mechanical prosthesis 1st trimester

Answer 7

Warfarin if < 5 mg

LMWH or UFH if > 5 mg

Question 8

Mechanical prosthesis 2nd trimester

Answer 8

Warfarin + ASA

Switch to UFH before delivery