Chest pain during pregnancy

Question 1

Aortic dissecion

Answer 1

Predisposing factors: HTN, congenital HD and Marfan's
Mainly Stanford A
Sudden tearing CP, transient syncope
Cold, clammy, hypertensive, AR murmur
Involvement of RCA may cause inferior MI

Question 2

AD management

Answer 2

<28 / 40 - aortic repair with the fetus kept in utero

28-32/40 - dependent on fetal condition

> 32/40 - primary C section followed by aortic repair at the same operation

Question 3

Mitral stenosis

Answer 3

Most cases associated with rheumatic HD
Becoming less common in British women, suspect in immigrant women
Commonest cardiac condition during pregnancy
Commonly associated with mortality
Valve surgery; balloon valvuloplasty preferable

Question 4

PE

Answer 4

Leading cause of mortality in pregnancy
Half dose scintigraphy; CT chest if underlying lung disease should aid diagnosis
Tx with LMWH throughout pregnancy and until 6 weeks post partum
Warfarin CI in pregnancy