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Flashcards in Maternal cardiac Deck (174)
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1

What is NYHA (New York Heart Association) class 1?

No cardiac symptoms

2

What is NYHA (New York Heart Association) class II?

Cardiac symptoms with greater than normal activity (e.g., carrying packages)

3

What is NYHA (New York Heart Association) class III?

Cardiac symptoms with normal activity (e.g., getting dressed)

4

What is NYHA (New York Heart Association) class IV?

Cardiac symptoms with bedrest

5

With which two NYHA classes is pregnancy not advised?

NYHA 3-4

6

How does cardiac dysfunction present?

Fatigue, limited activity, palpitations, tachycardia, SOB, chest pain, dyspnea on exertion, cyanosis

7

What 4 cardiac conditions are contraindications to pregnancy?

Pulmonary hypertension
Severe ventricular dysfunction
Aortic root dilation (>4cm)
Severe left-sided obstructive lesions

8

While cardiac disease complicates 1-4% of pregnancies, it accounts for what % of maternal mortality?

Up to 25%

9

For women with congenital heart disease, what is the risk of fetal transmission?

5% (from 8/1000 background risk)

10

What features of pregnancy physiology can exacerbate cardiac disease?

Increased intravascular volume
Hypercoagulability
Decreased SVR

11

What are the general guidelines for pregnancy management in women with cardiac disease?

Relative bedrest
Treat other medical conditions
Multidisciplinary approach
Monitor fetal growth q 4-6w
NST >34w

12

What are the general guidelines for labor management in women with cardiac disease?

Lateral decubitus position
EpiduralO2
+/- Endocarditis prophylaxis
Avoid hypotension (keep women ?wetter?)
C/S for obstetric indications

13

While most cardiac conditions benefit from relative hypervolemia and relative hypotension intrapartum, what is the exception?

Mitral stenosis

14

Why is fluid overload (ie post-partum autotransfusion) bad for mitral stenosis?

The associated restricted LV filling can lead to pulmonary edema

15

What are the indications for c/s with maternal cardiac disease?

Aortic root dilation >4cm
Maternal Coumadin
Recent MI
Severe aortic stenosis

16

Which cardiac patients/diagnoses may benefit from invasive monitoring in labor?

Women with preload dependent conditions (aortic stenosis, PHTN)

17

Should women with prospthetic cardiac valves receive endocarditis prophylaxis?

Yes (during endothelialization)

18

After what time period after repair of CHD with prosthetic material should women receive endocarditis prophylaxis with delivery?

6 months

19

Does completely repaired CHD (with repair >6m ago) require endocarditis prophylaxis?

No

20

Does unrepaired cyanotic CHD require endocarditis prophylaxis?

Yes

21

If your patient had repair of CHD with prosthetic material remotely but there are residual defects, should they receive endocarditis prophylaxis?

Yes

22

How do we manage a patient with prior infective endocarditis in labor?

With endocarditis prophylaxis

23

When endocarditis prophylaxis is indicated, what antibiotic is used?

Ampicillin 2g IV

24

For PCN allergic women who need endocarditis prophylaxis, what antibiotics can be used?

clindamycin, cefazolin, cetriaxone

25

Is there an ACOG resource to guide endocarditis prophylaxis?

Yes - committee opinion 421, Antibiotics prophylaxis for infective endocarditis

26

What is the workup for palpitations?

Thyroid function
Rule out drugs/caffeine/tobacco
EKG
Echo

27

Are PACs and PVCs more common in pregnancy and typically benign?

Yes

28

What is the risk of complication or death in pregnancy with isolated VSD, repaired or unrepaired (high, moderate, or low)?

Low, <1%

29

When you have a patient with a long-standing large VSD, what should you rule out prior to becoming pregnant?

Pulmonary hypertension

30

Why is decreased SVR bad with pulmonary HTN caused by a VSD?

If pulmonary pressures exceed systemic pressures, the typical L-> R shunt can reverse, resulting in cyanosis