Pregnancy And The Heart Flashcards
Not Normal exam findings during pregnancy
S4, loud systolic murmur, diastolic murmur, fixed split s2
Normal cardiac physical findings with pregnancy
Wide split s1
Systolic murmur (96%)
Loud S3 (84%)
Mammary Soufle
Dilated aortic root. When is it ok for pregnancy?
Diameter 4.5- No
Conditions to advise against pregnancy
Severe pulmonary hypertension
Severe obstructive lesions
–AS, MS, PS, HCM, coarctation
Ventricular dysfunction
- Class 3/4 CHF, EF 40-45mm
ASD in pregnancy. How do you manage?
Observation
Possible catheter based intervention or anticoagulant if CVA occurs in rare cases.
How do you manage aortic disorders in pregnancy?
Beta blocker
Fetal echo
Facilitated vaginal delivery
C-section for ao >40mm or increasing size
I.E. Prophylaxis
Postpartum dissection risk persists ? Increases with lactation.
When should you absolutely advise against further pregnancy in women with a history of peripartum cardiomyopathy?
EF ever
Treatment of congestive heart failure and pregnancy
Conservative dash of salt, bedrest
Limited medical therapy
– Digoxin, hydralazine, diuretic if necessary
– Aldosterone antagonist (avoid in first trimester secondary to anti-androgen effect)
Aspirin 81 mg. safe during pregnancy/ lactation?
Yes/yes
Metoprolol/Labetalol
safe during pregnancy/ lactation?
Yes/yes
Hydralazine
safe during pregnancy/ lactation?
Yes/yes
Lidocaine
safe during pregnancy/ lactation?
Yes/yes
Adenosine
safe during pregnancy/ lactation?
Yes/?
ACE-I or ARB
safe during pregnancy/ lactation?
No/yes
Amiodarone
safe during pregnancy/ lactation?
No/no
