Cardiovascular Disorders in Pregnancy
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Questions and Answers

By the third trimester, what is the typical displacement of the heart due to the elevated diaphragm?

  • Leftward and upward (correct)
  • Rightward and downward
  • Rightward and upward
  • Leftward and downward

    • Which factor primarily accounts for changes in cardiac end-systolic and end-diastolic dimensions during pregnancy?

  • Decrease in blood plasma volume
  • Increase in systemic vascular resistance
  • Decrease in red blood cell count
  • Increase in blood plasma volume (correct)

    • When do the most significant hemodynamic changes associated with pregnancy typically peak?

  • Immediately prior to delivery
  • Late third trimester
  • Second and early third trimester (correct)
  • Early first trimester

    • What is the primary function of the altered hemodynamic state during pregnancy?

    <p>To meet fetal physiological demands while maintaining maternal integrity (C)</p> Signup and view all the answers

    What is the approximate percentage increase in cardiac output observed during pregnancy?

    <p>30-50% (C)</p> Signup and view all the answers

    If a non-pregnant individual has a cardiac output of 4 L/min, what would be a typical cardiac output for a pregnant individual?

    <p>Approximately 6 L/min (B)</p> Signup and view all the answers

    When is the increase in cardiac output typically established and maintained during pregnancy?

    <p>It plateaus after the second trimester. (A)</p> Signup and view all the answers

    Which of the following best describes the timing of maximal pregnancy-induced hypervolemia?

    <p>After 28 weeks of gestation (B)</p> Signup and view all the answers

    What is the approximate increase in stroke volume during pregnancy?

    <p>25-30% (A)</p> Signup and view all the answers

    Which of the following physiological changes does NOT typically occur during pregnancy?

    <p>Increase in mean arterial blood pressure (A)</p> Signup and view all the answers

    By approximately how much does peripheral vascular resistance typically decrease during pregnancy?

    <p>20-30% (D)</p> Signup and view all the answers

    When during pregnancy are systolic and diastolic blood pressures typically at their lowest?

    <p>Around 6 to 7 weeks from the last menstrual period (C)</p> Signup and view all the answers

    An increase in heart rate to what level may warrant evaluation for underlying pathology during pregnancy?

    <p>Greater than 115 bpm (C)</p> Signup and view all the answers

    Which of the following is NOT a component of increased hemodynamic changes during pregnancy?

    <p>Systemic vascular resistance (C)</p> Signup and view all the answers

    What is the primary cause of decreased peripheral vascular resistance during pregnancy?

    <p>Vasodilation induced by progesterone (D)</p> Signup and view all the answers

    Which of the following is a potential consequence of insufficient hemodynamic changes during pregnancy?

    <p>Maternal and fetal morbidity (B)</p> Signup and view all the answers

    Which of the following hemodynamic changes is NOT typically observed during pregnancy?

    <p>Increased blood pressure (A)</p> Signup and view all the answers

    A pregnant woman presents with a bounding pulse and a prominent apical pulse. These findings are most likely due to:

    <p>Increased stroke volume. (D)</p> Signup and view all the answers

    A pregnant patient with pre-existing cardiac issues is at increased risk for maternal-fetal compromise due to which of the following?

    <p>Fixed cardiac output. (D)</p> Signup and view all the answers

    Which of the following parameters is decreased during pregnancy?

    <p>Colloid oncotic pressure (C)</p> Signup and view all the answers

    A pregnant patient presents with a sinus tachycardia towards the end of her pregnancy. This finding is most likely associated with:

    <p>Decreased systemic vascular resistance. (D)</p> Signup and view all the answers

    According to the WHO risk classification for CVD in pregnancy, which of the following conditions is categorized as WHO 1?

    <p>Uncomplicated, small or mild Pulmonic Stenosis (PS) (D)</p> Signup and view all the answers

    Which of the following clinical findings is NOT typically associated with normal hemodynamic changes in pregnancy?

    <p>Elevated JVP in first trimester. (D)</p> Signup and view all the answers

    A pregnant patient is at higher risk of cardiac failure due to an increase in:

    <p>Blood volume. (A)</p> Signup and view all the answers

    A patient reports experiencing dyspnea and fatigue only when walking more than 2 blocks. Based on the NYHA classification, which class best describes this patient?

    <p>Class II (A)</p> Signup and view all the answers

    A patient with a successfully repaired Ventricular Septal Defect (VSD) is classified under which WHO risk category for CVD in pregnancy?

    <p>WHO 1, risk no higher than general population (A)</p> Signup and view all the answers

    An individual has no cardiac symptoms during daily activities, but reports feeling palpitations after strenuous exercise, what NYHA class would they fit into?

    <p>Class I (B)</p> Signup and view all the answers

    Which of the following conditions requires a cardiology consult each trimester during pregnancy, according to the WHO risk classification?

    <p>Uncomplicated unoperated Atrial Septal Defect (ASD) (A)</p> Signup and view all the answers

    A pregnant patient is experiencing nose bleeds. This clinical manifestation is most likely associated with:

    <p>Increased blood flow. (C)</p> Signup and view all the answers

    A pregnant woman with a history of severe aortic stenosis is at increased risk of maternal-fetal compromise, primarily due to:

    <p>Fixed cardiac output. (C)</p> Signup and view all the answers

    Based on the WHO risk classification, what is the primary difference in the recommended cardiology consultation frequency between a patient with a successfully repaired ASD, and a patient with a repaired TOF?

    <p>The patient with a repaired TOF will need consultation each trimester, whereas the patient with a repaired ASD will only need one or two consultations (B)</p> Signup and view all the answers

    A patient is categorized within NYHA Class III. Which of the following best describes their symptoms?

    <p>Experiences symptoms with less than normal physical activity. (C)</p> Signup and view all the answers

    What is the estimated maternal mortality rate associated with severe pulmonary hypertension?

    <p>50% (B)</p> Signup and view all the answers

    A patient has become restricted to bed due to severe heart condition and experiences shortness of breath, even when lying down. Which NYHA class would they be most likely to align with?

    <p>Class IV (C)</p> Signup and view all the answers

    A patient presents with mild Left Ventricular (LV) impairment. According to the WHO classification, how is their risk category determined during pregnancy?

    <p>Her classification will depend on her individual case, she will be either categorized as WHO 2 or WHO 3 risk. (B)</p> Signup and view all the answers

    A patient exhibits symptoms of anginal pain during routine household tasks but reports they feel comfortable when sitting. Which functional class from the NYHA classifications is most appropriate?

    <p>Class III (D)</p> Signup and view all the answers

    If a patient is able to perform light housework without experiencing any symptoms, but reports fatigue when going up a flight of stairs, which NYHA class best reflects their functional capacity?

    <p>Class II (D)</p> Signup and view all the answers

    Which of the following best describes the progression of symptoms based on increasing NYHA functional class?

    <p>Symptoms occur more frequently at rest with increasing class number. (C)</p> Signup and view all the answers

    What is the key difference in physical activity limitation between a patient in NYHA Class II and a patient in NYHA Class III?

    <p>Class II patients have slight limitations during normal activities and class III have marked limitations in less than normal activities. (D)</p> Signup and view all the answers

    A patient is diagnosed with NYHA Class I. Which of these statements best characterizes their physical activity limits, in general?

    <p>They experience no limitations of physical activity. (D)</p> Signup and view all the answers

    A patient was previously diagnosed with NYHA Class II but now reports experiencing shortness of breath while simply sitting in a chair. Which of the following would be the most appropriate adjustment to their NYHA classification?

    <p>Reclassify to Class IV. (A)</p> Signup and view all the answers

    Flashcards

    Heart Position in Pregnancy

    The heart is displaced to the left and upward and rotated on its long axis due to the rising diaphragm in the third trimester.

    Cardiac Silhouette in Pregnancy

    The apex of the heart shifts laterally, resulting in a larger cardiac silhouette visible in chest X-rays during the later stages of pregnancy.

    Cardiac Dimensions in Pregnancy

    The increased blood volume in pregnancy leads to a larger size of the heart's chambers at both the end of contraction and relaxation.

    Timing of Cardiac Changes in Pregnancy

    Changes in blood flow and heart function during pregnancy begin early, peak in the second and early third trimesters, and stay relatively stable until delivery.

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    Purpose of Cardiac Changes in Pregnancy

    Pregnancy causes alterations in blood flow to meet the needs of both the mother and the growing fetus, ensuring the mother's cardiovascular system remains healthy.

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    Cardiac Output Increase in Pregnancy

    During pregnancy, cardiac output increases by 30-50%, reaching approximately 6 L/min.

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    Factors Affecting Hemodynamic Changes in Pregnancy

    Changes in blood volume, hormone levels, and the increased metabolic demands of pregnancy contribute to the overall alteration of blood flow dynamics in the mother's body.

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    Cardiac output

    The volume of blood pumped by the heart per minute. It increases during pregnancy to accommodate the growing fetus and placenta.

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    Stroke volume

    The amount of blood ejected from the left ventricle with each heartbeat. It increases during pregnancy due to increased blood volume.

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    Cardiac preload

    The volume of blood in the heart's chambers before contraction. It increases during pregnancy as blood volume expands.

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    Systemic vascular resistance

    The resistance blood encounters as it flows through the blood vessels. It decreases during pregnancy due to the effects of progesterone.

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    Systolic blood pressure

    The force exerted by the blood against the walls of the arteries when the heart contracts. It typically decreases during pregnancy.

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    Diastolic blood pressure

    The force exerted by the blood against the walls of the arteries when the heart relaxes. It typically decreases during pregnancy.

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    Mean Arterial Pressure (MAP)

    The average pressure in the arteries during a cardiac cycle. It typically decreases during pregnancy.

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    Resting pulse rate

    The heart rate increases modestly during pregnancy, contributing to the increased cardiac output.

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    Insufficient Hemodynamic Changes

    A condition where there are insufficient hemodynamic changes during pregnancy, potentially leading to health concerns for both mother and baby.

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    NYHA Class I

    This class represents women with no limitations in physical activity. They experience no symptoms of heart failure or chest pain.

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    NYHA Class II

    This class represents women with slight limitations in physical activity. They experience discomfort like fatigue, palpitations, shortness of breath, or chest pain during ordinary activities but feel fine at rest.

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    NYHA Class III

    This class represents women with significant limitations in physical activity. They experience discomfort like fatigue, palpitations, shortness of breath, or chest pain during even less than ordinary activities but feel fine at rest.

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    NYHA Class IV

    This class represents women with severe limitations in physical activity. They experience discomfort like fatigue, palpitations, shortness of breath, or chest pain even at rest and any physical activity makes it worse.

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    WHO Risk Category 2

    Pregnancy involving a heart condition with a small or mild increase in risk compared to the general population.

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    WHO Risk Category 1

    Pregnancy involving a heart condition with no higher risk than the general population.

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    WHO Risk Category 2 or 3

    This category is dependent on the individual case and may fall under either WHO Risk Category 2 or 3.

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    WHO Risk Category 3

    This category is characterized by a potentially significant increase in the risk of complications for both the mother and the baby.

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    WHO Risk Category 3

    This category is associated with a range of heart conditions, including a mild increase in the risk of maternal morbidity and mortality.

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    Hemodynamic Changes in Pregnancy

    Hemodynamic changes during pregnancy are adjustments in blood flow, volume, and pressure to support the growing fetus. These changes are essential for fetal growth and development.

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    Venous Hum

    A common sound heard in pregnant women due to increased blood flow through the arteries in the neck.

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    Ejection Systolic Murmur

    An abnormal heart sound (murmur) usually heard in the first trimester of pregnancy. It is due to the increased blood flow through the heart.

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    Sinus Tachycardia in Pregnancy

    A condition characterized by a rapid heart rate, often experienced in pregnant women towards the end of pregnancy.

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    Relative Sinus Tachycardia

    A condition where the heart rate is elevated by 10-20 beats per minute above the normal resting heart rate.

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    Ectopic Beats

    A condition where a fetal heartbeat is detected outside the uterus. It can be a sign of a serious health problem.

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    Systemic Vascular Resistance in Pregnancy

    A decrease in blood flow resistance throughout the body during pregnancy, allowing increased blood flow to the uterus and placenta for fetal nourishment.

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    Nose Bleeds in Pregnancy

    A common symptom in early pregnancy due to increased blood flow to the nose.

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    Heart Failure in Pregnancy

    A condition where the heart's ability to pump blood efficiently weakens, making it harder to deliver oxygen and nutrients to the body and fetus.

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    Study Notes

    Cardiovascular Disorders in Pregnancy

    • Physiological Changes: Cardiac output increases by 30-50%, stroke volume increases by 25-30%, and heart rate increases by 10-15 bpm. Systemic vascular resistance decreases by 20-30%. Blood volume increases by 40-50%. These changes begin early in pregnancy, peak during the second and early third trimester, and remain relatively constant until delivery.

    Hemodynamic Changes During Pregnancy

    • Increased Parameters: Cardiac output, stroke volume, plasma volume, preload, end diastolic volume, and end systolic volume all increase.
    • Decreased Parameters: Systemic vascular resistance, peripheral resistance, arterial pressure (both systolic and diastolic) all decrease.

    Physiologic Considerations

    • Anatomy: The diaphragm shifts upward and the heart moves laterally and slightly upward. The cardiac silhouette enlarges on chest radiographs.
    • Physiological Changes: These changes, which are crucial to meeting the fetus' needs while maintaining maternal health, allow the physiological demands of the fetus to be met. Key changes include an increase in cardiac output from 6 L/min. to 1.5L min., impacting the uterus, kidneys, skin, GI tract, and breasts.

    Clinical Implications of Hemodynamic Changes

    • Common Findings: Bounding/collapsing pulse, physiological anemia, higher risk of cardiac failure in multiple pregnancies, risk of maternal-fetal compromise in women with fixed cardiac outputs.
    • Other Findings: Sinus tachycardia toward the end of pregnancy, prominent non-displaced apical pulse, ejection systolic murmur, loud 1st heart sound, 3rd heart sound, venous hum, mammary souffle, relative sinus tachycardia (10-20 bpm), ectopic beats, peripheral edema, warm/erythematous extremities, elevated JVP in late pregnancy.

    Cardiovascular Disease Diagnosis in Pregnancy

    • Normal Pregnancy Indicators: Systolic and diastolic murmurs are common and considered part of normal pregnancy; respiratory effort is accentuated; and edema frequently accrues in lower extremities. This may interfere with diagnoses in pregnant patients.
    • Clinical Indicators: Dyspnea or orthopnea, nocturnal cough, hemoptysis, syncope, chest pain, cyanosis, clubbing of fingers, persistent neck pain/distention. Heart murmurs, cardiomegaly, persistent tachycardia and/or arrhythmias (tachycardia) persistent 1st and 2nd heart sounds are clinical indicators needing further investigation.

    Cardiovascular Disease Risk Assessment in Pregnancy

    • WHO Risk Classification: Classifies women based on risk of maternal mortality and morbidity to determine the optimal frequency of cardiology consultations during pregnancy. Categories range from low to high risk.
    • Associated Conditions: Conditions such as valvular diseases or congenital heart defects are associated with increased maternal and fetal risks during pregnancy.

    Peripartum Management Considerations

    • Antepartum Care: Multidisciplinary approach involving obstetricians, cardiologists, anesthesiologists, and other specialists to plan for the prevention of pregnancy complications and address issues. Infection prevention is a key concern for avoiding decompensation or complications during pregnancy.
    • Labor and Delivery: Preference for vaginal delivery, but cesarean section may be necessary for certain high-risk pregnancies such as women with dilated aortic roots, recent myocardial infarctions, or severe mitral stenosis.
    • Postpartum Care: Ongoing monitoring is crucial to ensure maternal recovery and the identification of any complications that may arise. Careful attention needs to be given to the potential for conditions of chronic disease.

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    Related Documents

    Cardiovascular Diseases in Pregnancy - Dr Marcaida PDF

    Description

    Explore the physiological and hemodynamic changes that occur in the cardiovascular system during pregnancy. This quiz covers increased and decreased parameters, as well as anatomical considerations crucial for fetal well-being. Test your knowledge on how these changes adapt throughout the different trimesters.

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