TRP slides Flashcards
5 Changements cardiovasculaires en grossesse
- Augmentation DC
- Augmentation FC
- Diminution TA
- Diminution resistance vasculaire périphérique
- Dilated cardiac chambers
7 Normal echo findings in pregnancy
- Dilatation cavités cardiaques (LV, RV, RA, LA)
- Fuites légères de tous les valves cardiaques
- Increased LV mass
- Increased cardiac output
- Increased stroke volume
6 normal cardiac physical exam findings in pregnancy
Tachycardia
Tachypnea
Decreased BP
B3
Venous hum
Mammary souffle
Systolic flow murmur
Elevated JVP
edema
5 classes of medications which are safe to use in HFrEF in pregnancy
Betabloqueurs (sauf atenolol)
Hydralazine
Nitrates
Digoxine
Lasix
Definition of PPCM
New onset heart failure within 1 month of delivery or up to 5 months post partum with LVEF < 45%, dx of exclusion.
6 Risk factors for the development of PPCm
- Age > 30
- Noir
- Diabète
- Multiparité
- Gemellaire
- Tabagisme
- Preeclampie
- Tocolyse
- Hx familiale
- ATCD personnel
Maternal physiological changes in pregnancy that may contribute to coronary events
Hypercoagulabilité
Relative anemia
Increased stroke volume
Upregulation of SRAA (Retention hydrosodée)
Increased circulating estrogen and progesterone (increased vascular fragility)
Etiology of coronary events in pregnancy
- Coronary atherosclerosis
- P-SCAD
- Vasospasme
- Microvascular dysfunction
- Coronary thrombosis
WHO classification pregnancy
WHO 1 - Mild PS, PDA, MVP, repaired simple lesions, ectopic beats
WHO 2 - ASD ou VSP unoperated, TOF repaired, most arythmias
WHO 2-3 - Mild LV impairment, HOCM, Valve disease not 1 or 3
Marfan without dilatation, aorta < 45 bic, repaired coarctation
WHO 3 - valve mécanique, ventricule systémique, fondant, cyanotic heart disease, complex congénital heart disease
WHO 4 - HTAP any case, LVEF<30% or NYHA 3-4, PPCM with residual impairment of LVEF
Severe mitral stenosis, severe symptomatic aortic stenosis, Mafarn > 45, Bic > 50 mm, native severe coarctation
Who class 4
HTAP any case
LVEF<30% or NYHA 3-4
PPCM with residual impairment of LVEF
Severe mitral stenosis
severe symptomatic aortic stenosis
Mafarn > 45
Bic > 50 mm
native severe coarctation
CCS high risk cardiac lesion
- Eisenmenger or severe PH
- Fontan complications
- SCAD
- PPCM with residual impairment
- Severe hereditary thoracic aortopathy
- Severe Sx AS or severe SM
- LVEF < 30% or LVAD
HF médications with are contraindicated in breastfeeding
Spironolactone
ISGLT2
ARA
ARNI
IECA sauf ECL
F 28 ans RVM mec. Desire grossesse. Fonction VG et valve normal. INR 3 avec coumading 4 DIE. 6 elements PEC.
- Counsel about risks prior to becoming pregnant
- Follow up closely with careful INR monitoring
- Warfarin throughout pregnancy if INR =3 with Coumadin < 5 mg
- Serial echo during pregnancy
- Switch to LMWH 1 week prior to delivery, IV heparin 36 hours prior, stop 4-6 hours prior (timings to be determined by high risk OB/MFM)
Pathology congénitales complexes
Unprepared cyanotic congenital heart defect
Fontan
Single ventricle physiology
Truncus arteriosis
TGA post atrial switch/mustard
Double outlet ventricle
Interrupted aortic arch
complex AV connections
6 Clinical conditions in which the thermodilution technique is unreliable as a measure of cardiac output
Tricuspid Regurgitation
Pulmonary Regurgitation
Left-Right Shunt (ASD, VSD, PDA)
Low CO
SVR and PVR calculation
(TAM- POD) / CO
(PAPm-Wedge) / CO
Gorlin et Hakki AVA
CO / HR x systolic ejection period x 44.3 x square root (pic an pic)
HAKKI CO/square root (pic à pic)
Constriction KT
LVEDP - RVEDP < 5 mmHg
RVEDP/RVSP > 1/3 (TA différentielle moindre)
PASP< 55 mmHg
LV/RV interdependence
When is a full shunt run indicated
if Saturation PA - Sat SVC > 7%
QP: QS
(Sat Aorte - Sat MV) / (Sat Vp - Sat AP)
