Pregnancy and Heart Disease

Question 1

Patients should be counseled to avoid pregnancy or consider induced abortion if?

Answer 1

They have severe heart disease:
1- Ejection fraction less than 30%
2- Class III/IV heart failure
3- severe valvular stenosis
4- Marfan syndrome with aortic diameter > 45 mm
5- Bicuspid aortic valve with aortic diameter > 50 mm
6- Pulmonary artery hypertension.

Question 2

All pregnant/postpartum patients with chest pain should undergo:

Answer 2

standard troponin testing

EKG

Question 3

DD peripartum Cardiomyopathy?

Answer 3

1-  PE
2- Preexisting (undiagnosed) Heart Disease
3- Pulmonary Edema (Preeclampsia)
4- MI
5- Amniotic Fluid Embolism

Question 4

Risk factors peripartum Cardiomyopathy?

Answer 4

1- Multifetal Gestation
2- Obesity
3- Multiparity
4- Hypertensive disorders in pregnancy
5- AMA/teen

Question 5

Meds Peripartum Cardiomyopathy?

Answer 5

1- Lasix [for preload]
2- Beta Blocker
3- ACE-inhibitor for afterload (weeks later)

Question 6

MGMT Peripartum Cardiomyopathy?

Answer 6

1- Transfer to ICU/Multispecialty care team!
2- Telemetry with continuous cardiac monitoring
3- Supplemental O2
4- Monitor UO
5- Monitor electrolytes

Question 7

Definition Peripartum Cardiomyopathy?

Answer 7

Heart failure 1 month prior to or 12 weeks postpartum with absence of another identifiable cause of HF. LVEF<45%