Heart disease with the pregnancy🖤 Flashcards
(39 cards)
Mortality due to heart disease
Decrease or increase
Decrease
Pregnancy with heart disease has increase or decrease
Increase
Congenital heart disease with pregnancy increase or decrease
Increase
Hemodynamic changes in normal pregnancy
1. Plasma volume.
2. Cardiac output.
3. Heart rate.
4. Main arterial pressure.
5. Struck volume.
6. Systemic vascular resistance
7. Pulmonary vascular resistance.
جدول
40+
43 +
17 +
4+
27 +
21 -
34 -
What’s the critical period in pregnant women to get cardiac disease ?
- 6-30 wks
- Intra partum period
- after delivery
Pregnancy changes mimic cardiac disease? 5
• Symptoms – breathlessness, weakness, edema, syncope
• Tachycardia
• Splitting of 1st hear sound
• Murmur – systolic , breast bruit
• Displacement of apex beat – upwards to left
Symptoms of heart disease? 5
• Progressive dyspnea or orthopnea
• Nocturnal cough
• Syncope
• Chest pain
• Hemoptysis
Clinical findings of heart disease 9
• Cyanosis
• Clubbing of fingers
• Persistent neck vein distention
• Systolic murmur grade 3/6 or greater • Diastolic murmur
• Cardiomegaly
• Persistent arrhythmia
• Persistent split second sound
• Pulmonary hypertension
If you suspect the pregnant women maybe has cardiac disease what’s the investigation you want required?
• ECG – cardiac arrhythmias, hypertrophy
• Echocardiography – cardiac status and structural anomalies
• X-ray chest – cardiomegaly, vascular prominence
• Cardiac catheterization - rarely
Functional grading of heart disease?
•Grade I: No limitation of physical activity- asymptomatic with
normal activity
• Grade II: Mild limitation of physical activity -Symptoms with
normal physical activity
• Grade III: Marked limitation of physical activity -Symptoms
with less than normal activity, comfortable at rest
• Grade IV: Severe limitation of physical activity- symptoms at
rest
Classification of Heart Disease according to etiology :6
- Congenital - non cyanotic:
ASD, VSD, Pulmonary stenosis, coarctation of aorta - cyanotic :
fallot’s tetralogy
Eisenmenger’s syndrome - Rheumatic heart disease : – MS, MR, AS, AR
- Cardiomyopathy
- Ischemic heart disease
- conduction defects, syphilitic,
thyrotoxic, hypertensive
Classification of Heart Disease during pregnancy according to risk :
- Low risk ( 0 – 1%) – ASD, VSD, PDA, MS-1,2, corrected FT
- Medium risk ( 5 – 15 %) – MS-3,4, MS with atrial fibrillation, AS, uncorrected FT.
- High risk ( 25 – 50%) – PH, Eisenmengers Syndrome, aortic coarctation with valvular involvement, Marfans with aortic involvement.
Poor prognostic indicators 7.
• h/o heart failure, ischemic attack, stroke
• Arrhythmias
• Base line NYHA class 3 and 4
• MV area below 2cm sq, AV area below 1.5
• Ejection fraction less than 40%
• Oxygen saturation less than 80% Increased of fetal growth restriction
• Less than 20% chance
risk factors for pregnant women to get cardiac disease? 9
• Anemia
• Infections
• Hypertension
• Physical labor
• Weight gain
• Multiple pregnancy
• Caffeine , alcohol intake
• Pain
• Drugs – tocolytic
Effect of pregnancy on heart disease 6
• Worsening of cardiac status
• CCF,
• bacterial endocarditic,
• pulmonary edema,
• pulmonary embolism,
• rupture of aneurism
How are you gonna manage pregnant women with the cardiac disease ? require
• High index of suspicion
• Timely diagnosis
• Effective management
• Team Approach : 1.Obstetrician 2. Cardiologist 3 Anesthetist 4. Neonatologist 5. CTV surgeon 6. Nursing Staff
Preconceptional counseling 4.
• No pregnancy specially in high risk types
• Maternal mortality varies directly with functional classification at pregnancy
onset
• pre-pregnancy Optimal Medical/Surgical treatment
• Counseling- :
• Maternal & Fetal risks
• Prognosis
• Social and cost considerations
• Hospital delivery- Preferable at tertiary care centre
• Use of anticogulants
When Medical termination of pregnancy use?
- early pregnancy in high-risk group only ( 1. Primary pulmonary HTN, 2. Eisenmenger syndrome, 3. Coarctation of aorta, 4. Marfan syndrome with dilated aortic root ).
- Only in 1st trim, better before 8 weeks.
- Suction evacuation preferred.
- MTP also carries risk for life.
Patient with the cardiac disease what’s the best method for the medical termination?
Suction evacuation.
Antenatal care for pregnant women with the cardiac disease 6
• Clear counseling of risk and prognosis.
• ANC every 2 weeks up to 30 weeks then weekly.
• On each visit-note-pulse rate, BP, cough dyspnea, weight, anemia, auscultate lung bases, re-evaluate functional grade.
• Ensure treatment compliance.
• Exclude fetal congenital anomaly by level-III USG and fetal ECHO at 20 weeks in maternal congenital heart disease.
• Fetal monitoring.
The pregnant women with cardiac diseases, what you gonna use as a treatment Anticoagulants
Heparin and the first 12 weeks to decrease risk.
What’s the advantage of the heparin?
Doesn’t cross the placenta.
What’s the disadvantage for Heparin?
maternal osteoporosis, hemorrhage, thrombocytopenia, thrombosis
Why we doesn’t use Warfarin in the pregnant woman with the cardiac disease?
abnormalities of fetal bone and cartilage formation
