Pregnancy Flashcards

1
Q

Pregnancy induced HTN/Gestational HTN

A

No HTN prior to 20 weeks, HTN during pregnancy and up to 6 weeks post delivery

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2
Q

Pre-eclampsia

A

HTN in 2nd half of pregnancy with >0.3gm protein (24 hour urine)
Proteinuria >2.0g 24 hrs
low plts
epigastric pain

Indication for delivery - HELLP, >38weeks, bad fetal testing, olgiohydraminos, fetal growth restriction

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3
Q

Aortic coarcation

A

Radial-femoral delay

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4
Q

HELLP

A

pre-eclampsia, elevated liver enzymes, hemolytic anemia and thrombocytopenia (platelets)

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5
Q

Symptomatic MS in pregnancy

A

FIRST - medical therapy - BB/Anticoag (inc’d HR in 3rd trimester increses MS gradient has diastolic filling time decreases)
then interventional options

Perc Balloon Mitral Valvuloplasy - increased need for CO via inc in HR and SV in 3rd trim - if HR increased, MS gradient worsens

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6
Q

Treatment of Pre-eclampsia

A

Urgent delivery - gestation HTN/proteinuria with associated pulmonary edema, coagulopathy, fetal distress

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7
Q

Pregnant chronic HTN patients

A

Goal <140/90\

Anti-HTN agents if >160/110 (methyldopa/BB ie labetolol)

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8
Q

Coronary artery dissection

A

CP/dypnea
ST elevations
JVP
tachycardia, HTN

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9
Q

Post partum CM

A

Mech support
Transplant eval
ACEi/BB once stable BP/euvolemic
A/C

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10
Q

MS in pregnancy

A

1st: Tx with BB increase diastolic filling time, maintain SR
2nd: Balloon valvuloplasty of MV
If afib - rate control with metoprolol or quinidine, digoxin, non-dihydropyridine CCB - need to consider A/C
3rd - surgery - bypass is 20-30% fetal risk so last resort…

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11
Q

Pregnancy with Structural Heart Disease

A
CO dec
SV dec
LV mass dec
dec'd SVR
inc'd plasma vol - inc'd preload - inc'd CO (not well tolerated in patients with Str Heart dz
E/E' ratio increases - elevated PCWP
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12
Q

Regurgitant lesions in preg

A

well tolerated

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13
Q

Gestational HTN

A

2x r/o CAD - aggressive risk factor screening

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14
Q

Pregnancy and Marfans

A

ok if Ao<4.0cm

replace pre-preg if >4.0cm

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15
Q

Anticoagulation in pregnancy mechanical valve

-increased mortality or serious complications in pregnancy with mech valves

A

Warfarin not harmful to fetus at <=5mg daily
change to UFH just prior to delivery

Warfarin dose >5mg daily
1st trimester UFH (two fold control) or LMWH (anti Xa 0.8-1.2) - NOT WEIGHT BASED with inc’d vol of distribution during pregnancy
Warfarin 2nd and 3rd trimesters and UFH just prior to delivery

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16
Q

Peripartum CM

A

Recovered EF
20% risk of recurrence of PPCM

Persistent LV dysfxn
40% recurrence PPCM
20% maternal mortality

17
Q

SVT in preg

A

metoprolol and propranolol ok (avoid first trimester)
sotolol and flecanide also ok
digoxin also ok
ablation during pregnancy only if refractory to Rx tx