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3 Cardiovascular Disorder and Pregnancy

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1. Maternal Cardiac Dis- organic heart disease

ease

2. rheumatic heart dis- a condition in which the heart valves have been per-
ease manently damaged by rheumatic fever. It is the most
commonly acquired heart disease in people under
age 25.

3. group A Streptococ- Bacteria called _____________________________

cus (group A strep) cause these infections.

4. Hypertensive heart It usually takes about 1 to 5 weeks after one of these

disease •Congenital infections for rheumatic fever to develop: (2)
heart disease.

5. • Fetal death rates are substantially increased in

women with any of these diagnosis; in fact, the still-
birth rate is doubled compared with that in women
without organic heart disease.
• The presence of organic heart disease also
significantly increases the risk of delivery of a
low-birth-weight infant (< 2500 g).

6. Vasoconstriction of Main effect of nicotine in gestational parameters

uteroplacental blood
vessels. This con-
striction occurs be-
cause nicotine stim-
ulates the release
of certain hormones
and neurotransmit-
ters that lead to a de-
crease in the diame-
ter of blood vessels.

7. Left side-lying posi- To optimize blood flow to the uterus and reduce the
tion/ Left lateral posi- risk of respiratory distress in the baby, pregnant indi-
tion viduals are often encouraged to adopt positions that
enhance blood circulation. What is this position?

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8. Left-sided Heart Fail- A cardiac disease that happens when the left ventricle
ure cannot shunt the blood forward that it received by the
left atrium from the pulmonary circulation.

•Failure mostly occurs at the level of the mitral valve.

9. pulmonary hyperten- •When the mitral valve could not push the
sion. blood forward, it causes back pressure on
the pulmonary circulation which results in
_________________________.

10. miscarriage, preterm • Pulmonary hypertension in pregnant women

labor, or maternal could precipitate a high-risk pregnancy for
death spontaneous __________,_________________, or
__________________.

11. (a) pulmonary edema • The placenta may not receive adequate blood be-
(b) chest and head el- cause of the decreased peripheral circulation.
evated
(c) 30th to 32nd week • The woman would have difficulty in sleeping due to
the worsening (a)_______________________.

• Advise the woman with left-sided heart failure to

sleep with her (b)________________________.

• Heart action is more effective at rest, so the inter-

stitial fluid returns to the circulation and overburdens
it, causing increased left-sided failure and pulmonary
edema.

• When complications of left-sided failure occur, these

may result in impaired blood flow to the uterus, poor
placental perfusion, intrauterine growth restriction,
and fetal mortality.

• The woman needs to have a seri-

al ultrasound and nonstress tests on the
(c)_________________________ of her pregnancy
to monitor fetal health.

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12. (a) Right-sided heart (a) ________________________ happens when the
failure output of the right ventricle is less than the blood
(b) Jugular vein dis- volume received by the right atrium from the vena
tention and increased cava.
portal circulation
(c) Liver • Back-pressure from this results in congestion of
the systemic venous circulation and also decrease in
cardiac output.

• Pressure is high in the vena cava,

leading to (b) ______________________ and
_________________________.

• (c) ___________ is enlarged, and this could cause

extreme dyspnea and pain in a pregnant woman be-
cause the enlarged liver is pressed upward by the
enlarged uterus, and extreme pressure is placed on
the diaphragm.

13. Eisenmenger syn- • ______________________ is the congenital anom-

drome aly that would most likely cause right-sided heart
failure in women of reproductive age.

• It is a right to left atrial or ventricular septal defect

with pulmonary stenosis.

14. Venous sinus throm- VST

boses (VST)

15. Patent ductus arterio- PDA

sus (PDA)

16. Tetralogy of Fallot TOF (clinical manifestation)

(TOF)

17. Eisenmenger syn- is the development of pulmonary hypertension (high

drome blood pressure in the lungs) due to an untreated con-
genital heart defect. The disease can cause compli-
cations including permanent heart and lung damage.

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18. Ventricular Septal De- VSD; hole in the ventricular septum
fect

19. 1. Ventricular Sep- Tetralogy of Fallot is a heart condition, but instead

tal Defect (VSD) - of thinking of it as one problem, you can break it
hole in septum; poor down into four smaller issues - that's why it's called
oxygenated blood is "tetralogy," which means a set of four things.
mixed with rich oxy-
genated blood. Here are the four things that happen with Tetralogy of
2. Pulmonary Steno- Fallot: (4)
sis - pulmonary valve
is smaller than usual
3. Overriding Aorta -
aorta is placed a bit
too much over the
hole in the septum
4. Right Ventricular
Hypertrophy (RVH) -
the muscle in the
right ventricle (one of
the heart's chambers)
becomes thicker

20. aorta biggest artery

21. left to right shunt ’ FLOW CHART

Increased pulmonary
blood flow ’
Endothelial Dysfunc-
tion and Pulmonary
Vascular remodeling
’ Increase in pul-
monary vascular re-
sistance ’
Inverted shunt; right
to left ’
Eisenmenger Syn-
drome

22. READ
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Mothers with Cardiac Disease cannot labor so they
do caesarean procedure. But as much as possible,
women with this anomaly are advised to avoid getting
pregnant.

23. READ •Oxygen administration and frequent assessment of

the arterial blood gas is needed to ensure fetal growth
once the woman gets pregnant.

•The nurse's role during labor is to closely monitor for

hypotension after epidural anesthesia.

24. Lidocaine (also (2) Local Anesthesia

known as Xylocaine)
Bupivacaine (also
known as Marcaine)

25. chronic hypertensive Women already diagnosed with

vascular disease _______________________________ already has
an elevated blood pressure (140/90 mmHg and
above) in pregnancy.

26. beta-blockers and The primary care provider could pre-

ACE inhibitors scribe ____________________________ and
______________________ to decrease the blood
pressure by peripheral dilation, but not to reduce it
below the threshold that allows for good placental
circulation

27. Venous Thromboem- happens more likely in pregnant women because of

bolic Disease (VTD) the stasis of blood in the lower extremities due to
uterine pressure and the effect of elevated estrogen
on the hypercoagulability of the woman.

28. deep vein thrombosis Women who are 30 years and old-
er have an increased risk of developing
__________________________ leading to pul-
monary emboli.

29. Pain and redness

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______________________ in the calf of the leg usu-
ally signal thrombus formation.

30. constrictive Thrombus formation can be prevented by avoiding the

knee-high stockings use of ___________________________________.

Advise the woman not to sit with her legs crossed at

the knee and to avoid standing in one position for a
long time.

31. Virchow's Triad postulates the presence of three factors that predis-
poses a person to develop vascular thrombosis

32. 1. Venous stasis, Implicates three contributing factors in the formation

2. Vascular injury, of thrombosis: (3)
and
3. Hypercoagulability

33. Venous stasis is the most consequential of the three factors, but sta-
sis alone appears to be insufficient to cause thrombus
formation

34. Doppler ultrasonog- A thrombus that occurred during pregnancy is

raphyand a woman's diagnosed by _________________________ and
history _______________________

35. 24 to 48 hours The woman will be placed on bed

Protamine Sulfate or rest and intravenous heparin admin-
Vitamin K istration for _______________________.(AN-
TIDOTE: ______________________or
___________________)

36. heparin Women who are taking _________________ dur-

episiotomy or epidur- ing pregnancy are not candidates for routine
al anesthesia to pre- ____________________or __________________.
vent hemorrhage

37. episiotomy incision into the vulva (laceration in perineum)

38. TRUE
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TRUE or FALSE

When Heparin and coumadin (warfarin), anticoag-

ulants, when ingested by the mother, DO NOT
BREASTFEED.

39. Partial Thromboplas- PTT determination should be continued during labor.

tin Time What is PTT?

40. pulmonary embolism The main danger of thrombophlebitis is

_______________________ or a clot that lodges in
the pulmonary artery, blocking the circulation to the
lungs and heart.

41. chest pain, Symptoms of pulmonary embolism include: (5)

sudden onset of dys-
pnea,
cough with hemopty-
sis,
tachycardia, and
severe dizziness or
fainting

42. "immediate emer- Pulmonary embolism is recognized as an

gency" ___________________________.

43. Catheter-directed uses a catheter with holes at the tip, which is posi-
percutaneous tioned up against the clot in the lungs.
thrombolysis
• The catheter is then left in place for 12 to 24 hours
while a steady infusion of medicine is delivered direct-
ly into the clot to help it dissolve.

44. 1. Cardiopulmonary The treatment approach for acute PE should always

support consists of three major components:
2. Anticoagulation
to prevent extension
and recurrence
3. Reperfusion of the
PA
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45. Cardiopulmonary In the three major components, what should first be

support initiated with methods such as supplemental oxygen
and inotropic agents

46. Pulmonary Embolec- this is surgery done to remove a PE.

tomy
It is generally done only in severe cases:
• PE is very large, you can't get anticoagulation and/or
thrombolytic therapy due to other medical problems
• you haven't responded well to those treatments,
• Unstable CONDITION.

47. ventilation-perfusion is a nuclear medicine scan that uses radioactive ma-

(VQ) scan terial (radiopharmaceutical) to examine airflow (ven-
tilation) and blood flow (perfusion) in the lungs.

The aim of the scan is to look for evidence of any

blood clot in the lungs, called pulmonary embolism
(PE).

48. electrocardiogram when someone presents with chest pain

(ECG) or symptoms suggestive of a cardiac is-
sue, healthcare professionals often perform an
_________________________________ as part of
the initial assessment.

49. Angina pectoris, a medical term that refers to chest pain or discomfort
commonly known as caused by reduced blood flow to the heart muscle.
angina

50. Platelets, also known are small cell fragments in the blood that play a crucial
as thrombocytes role in blood coagulation, or the process of forming
blood clots.

51. READ When extracting cerebrospinal fluid (CSF), anesthe-

sia induction is NOT recommended as it may involve
the risk of nerve injury leading to paralysis and po-
tential complications, including the development of
hydrocephalus in the baby.
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