Karnataka PGET Obstetrics MCQ Answer 4

Introduction:

• Complicates about 1% of pregnancies.
• Still significantly contributes to maternal mortality-8% of maternal deaths
  

Types:

• Rheumatic heart disease with mitral stenosis - about 80%.
• Congenital heart disease- patent ductus arteriosus, coarctation of aorta, pulmonary stenosis, atrial septal defect, ventricular septal defect.
• Hypertensive heart disease.
• Less common types: coronary, thyrotoxic, syphilitic, cardiomyopathy, cor pulmonale etc.

Complications:

• Pulmonary edema.
• Congestive cardiac failure.
• Pulmonary embolism.
• Subacute bacterial endocarditis.
• Rupture of cerebral aneurysm.
• Death usually can occur- during 28-32 wk, during labor, immediately after delivery of during first week of puerperium.
• Fetal loss can occur in severe grades due to prematurity and IUGR.
  

Pathophysiology:

• Normally cardiac output increases by 40%, max. by midpregnancy- ↑ stroke volume, ↑ blood volume & ↓peripheral vascular resistance.
• Compromised heart with poor reserve power cannot withstand the strainà cardiac failure.
• Functional systolic murmur due to hyperdynamic circulation is common during normal pregnancy, pedal edema also may be normal. Has to be differentiated from pathological condition.
  

Clinical Indicators:

• History of severe or progressive dyspnea, orthopnea, paroxysmal nocturnal dyspnea, hemoptysis, syncope with exertion, chest pain on exertion.
• Physical examination: cyanosis, clubbing, persistent neck vein distension.
• Systolic murmur >grade 3/6 with thrill.
• Diastolic murmur.
• Cardiomegaly
• Arrhythmia.
  

Investigations:

• Noninvasive- ECG, Echocardiography, X-ray chest with abdominal shield.