Pregnancy and cardiac diease

Question 1

During pregnancy, on average how much does blood volume increase

Answer 1

50%

Question 2

Majority of blood volume increase occurs during which trimester?

Answer 2

1st

Question 3

CO increases by _____% due to increased SV and a slight increase in HR (10bpm)

Answer 3

30-50%

Question 4

Red cell and plasma volume _____ (increase/decrease)

Answer 4

Increase

Question 5

In pregnancy and heart disease it is common to see:

Answer 5

• SOB
• Exercise intolerance
• Fatigue
• Third heart sound
• Low-grade systolic ejection murmur
  (last two are due to increased CO)

Question 6

Pregnancy poses the highest maternal and fetal morbidity and mortality for patients who have:

Answer 6

• Sig. obstructive valvular lesions
• Pulmonary hypertension
• Sig. pathology of the thoracic Ao
• Class III or IV heart failure
• Uncontrolled hypertension

Question 7

Patients should avoid or terminate pregnancy because of high risk to maternl or fetal morbidity and mortality:

Answer 7

• Pulmonary HTN w/PA systolic pressure > 70 mmHg
• Symptomatic obstructive lesions
• Marfan’s Syndrome w/dilated Ao
• DCM w/heart failure

Question 8

Peripartum Cardiomyopathy

Answer 8

The development of dilated cardiomyopathy of unexplained etiology, resulting in CHF, which is temporarily related to gestational period

Question 9

Causes of peripartum cardiomyopathy

Answer 9

• Myocarditis of viral or immune origin
• Nutritional deficiency
• Small vessel CA disease
• Hormonal effects
• Toxemia

Question 10

HTN during pregnancy is an increase in systolic BP of ____mmHg or more or an increase in diastolic BP of _____mmHg or more

Answer 10

• 30 mmHg
• 15 mmHg

Question 11

Chronic HTN is BP more than ____mmHg before pregnancy or before 20 wks or that persists longer than 6 wks postpartum

Answer 11

135/85 mmHg

Question 12

Pre-eclampsia/Eclampsia:

Answer 12

The development of HTN after more than 20 wks gestation that is accompanied by proteinuria or edema, or both

Question 13

______ is the leading cause of maternal death in developed countries

Answer 13

Pulmonary embolism

Question 14

What causes an increase in lower extremity DVT

Answer 14

Anatomic venous stasis caused by uterine compression

Question 15

What is recommended in high risk patients for venous thromboembolic disease (lower extremity DVT)

Answer 15

Prophylaxis (anticoagulation)

Question 16

Condtions that require antibiotic prophylaxis during complicated vaginal delivery or in the presence of infection:

Answer 16

• Unrepaired VSD
• Residual VSD or PDA after repair
• Valvular stenosis
• Ao coarc (repaired or not)
• h/o bacterial endocarditis
• Comlpex cyanotic heart disease
• Prosthetic valve (bioprosthetic or homograft)
• Pulmonary shints or conduits put in by surgical repair
• Bicuspid AoV
• Acquired valvular dysfunction
• HOCM
• MVP w/regurg or thick leaflets

Question 17

Since plasma increases more, it results in?

Answer 17

Physiologic anemia

Question 18

When does peripartum cardiomyopathy usually occur?

Answer 18

1 mo before childbirth to 6 mo after

Question 19

HTN during pregnancy is an _____ in systolic BP of 30 mmHg or more or an _____ in diastolic BP of 15 mmHg or more (increase/decrease)

Answer 19

Increase
Increase