Cardiac Disease in Pregnancy Flashcards
What is cardiac disease in pregnancy?
Cardiac disease in pregnant women
What is the aetiology of cardiac disease in pregnancy?
· Congenital heart disease – PDA, ASD, VSD, TOF, CoA, ESMS
· Acquired heart disease – IHD and valve disease
· Cardiomyopathies – peripartim CMP: CMP with HF, occurring in the 4 weeks before term date and persisting 5 months after delivery.
What is the RFs for cardiac disease in pregnancy?
FHx, obesity, age, HTN, smoking
What is the epidemiology of cardiac disease in pregnancy?
Increasing prevalence with higer maternal age and CVD risk in population.
What is the history in cardiac disease in pregnancy?
Assess new or deteriorating symptoms: SOB, palpitations, orthopnoew, PND, low exercise tolerance, chest pain.
What examinations would you do for cardiac disease in pregnancy?
· General: pulse, BP, JVP, odema, cyanosis
· Chest: heart sounds, murmurs (ESM common in pregnancy) basal crepitations
· Abdomen: fundal height (IUGR)
What are is the pathology of cardiac disease in pregnancy?
Dependes on aetiology above. 40% increase in BV during pregnancy, therefore cardiac strain. CVD previous = unable to increase CO -> uterine hypoperfusion
What management would you do for cardiac disease in pregnancy?
General: obstetrics/cardiology care during pregnancy.
· Preconceptual: assess cardiac status, address risk. Optimise tx monitor clotting and fetus.
· Delivery: consider optimum mode and timing of delivery, consult with anaesthetist, fluid management.
· Post partum surveillance (haemodynamic change)
What are the complications/ prognosis of cardiac disease in pregnancy?
Maternal progression of disease, VTE, POD, death. Fetal PTL, CHD, IUGR, teratogenic drugs. High maternal death (LVEF<40% -> 50% death). Marfans syndrome patients with aortic root >4.5cm advised against pregnancy. .
What investigations would you do for cardiac disease in pregnancy?
· Bloods: FBC, UE, LFT.
· Cardiac: Echo, ECG.
· Fetus: serial USS for growth, cardiac anomaly if congenital.
