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Cardiac disease

Cardiac disease






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    Cardiac disease Cardiac disease Presentation Transcript

    • Cardiac Disease
    • Incidence Cardiac Disease
      • Ranges 0.5-2%
      • Rheumatic fever used to be responsible for 88% of cardiac disease
      • Now responsible for @50%
      • Congenital heart disease now more prominent but since better management in childhood pregnancy outcomes generally positive
      • Mitral valve prolapse is most frequently seen valve defect in pregnant women
    • Etiology Cardiac Disease
      • Rheumatic fever
      • Valve deformities
      • Congenital heart disease
      • Developmental abnormalities
      • Congestive cardiomyopathies
      • Cardiac Dysrhythmias
    • Cardiac Disease – Diagnosis During Pregnancy
      • Based on presentation of symptoms
      • If diagnosis not already known usually made by cardiologist
      • Tests
        • ECG
        • Lab tests (cardiac enzymes and electrolytes_
        • Chest Xray
    • Cardiac Disease – General Management
      • OB and cardiologist work together
      • Cardiac meds need to be compatible with pregnancy
      • Dosages of meds adjusted when signs and symptoms worsen
      • Early US to help with dating
      • @28 weeks US to determine fetal growth and well being
      • EFM and BPP usually started @ 24 weeks
    • Cardiac Disease General Management
      • Bedrest or restricted activity in last trimester for Class III
      • Possible limitations for Classes I and II (but not usually necessary)
      • First big hurtle @28 – 32 weeks (Maximum volume present)
      • If Rheumatic fever then antibiotics
      • Everything aimed at < cardiac workload
      • Vaginal delivery preferred if possible
      • Critical care monitoring may be needed for severe cardiac problems
    • Cardiac Disease – Drugs
      • Dependent on cardiac lesion (need to be concerned about fetal risks)
      • Heparin
      • Lasix
      • Digitalis
      • Beta blockers
      • Antidysrhythmics
    • Antepartum Physiology
      • Cardiac output  as early as 1 st trimester
      • Continues to rise (due to  in plasma volume)
      • Reaches plateau between @28-32 weeks
      • Signs and symptoms similar to those of cardiac disease
        • Dyspnea
        • Orthopnea
        • Dyspnea with exertion
        • Occasional palpatations
        • Edema
        • Fatigue
    • Intrapartum
      • Work load of heart increased due to labor
      • Uterine contractions normally increase cardiac output and stroke volume because of the increased intravascular volume
      • Positioning very important
        • Laterally
        • Providing pain relief as needed
    • Postpartum
      • Remobilization of fluid after delivery into the intravascular compartment after placenta delivered
      • Important to be cautious with IV fluids and Pitocin after delivery (risk of pulmonary edema)