Professional Documents
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Cardiovascular Disease in Obstetrics
Cardiovascular Disease in Obstetrics
in obstetrics
Slight increase in HR
CV in pregnancy Big Picture
Pulmonic Mitral
Resistance arterioles
Pulmonary LV failure /
capillaries ischemia
(edema)
Tricuspid Aortic
Stenosis
Pulmonic Mitral
Otherwise, good to go
Small ASD, VSD or PDA
No IV bubbles (LR shunt can reverse).
Epidural LOR with saline, not air
Pain increased SVR increased LR
shunt ?RV failure?
Slow onset epidural preferred. Avoid
sudden drop in SVR which could cause
RL shunt and maternal hypoxia.
Small ASD, VSD or PDA
Memorize (and avoid) causes of pulmonary
artery vasoconstriction:
Alveolar hypoxia
Hypothemia
Hypercarbia
Acidosis
Pain
home.cc.umanitoba.ca/~soninr/PS.h
www.med.yale.edu/.../cardio/chd/e_a
tml
sd/index.html
Coarctation of aorta
Uncorrected, is a very
dangerous lesion in
pregnancy.
Increased afterload
for heart, decreased
perfusion for uterus.
Risks: LV failure,
aortic rupture,
endoaortitis.
More common in
males.
www.mayoclinic.org/coarctation-aorta/about.htm
Dilated collaterals in coarctation
www-clinpharm.medschl.cam.ac.uk/.../index.html
Descending thoracic aortic coarctation repaired with stent
www.med.yale.edu/.../c_coarct_1815204/index.html
Tetralogy of Fallot
http://www.nhlbi.nih.gov/health/dci/Diseases/tof/tof_what.html
Marcus JT
Dong SJ. Smith ER. Tyberg JV. Changes in the radius of curvature of the ventricular septum at end diastole during pulmonary
arterial and aortic constrictions in the dog. [Journal Article] Circulation. 86(4):1280-90, 1992 Oct.
Tetralogy of Fallot
Patients with corrected TOF should have
periodic echocardiograms.
www.rjmatthewsmd.com/Definitions/pop/22fig.htm
Eisenmengers Syndrome
Increased pulmonary flow (LR shunt due to
ASD, VSD or PDA) causes hypertrophy of
pulmonary arteries pulmonary hypertension
reversal of shunt to RL with cyanosis.
www.radiofreeithaca.net/search/Hippocrates
www.rjmatthewsmd.com/Definitions/pop/
23jfig.htm
tchin.org/portraits/angela-1.htm
Pulmonary Hypertension (PH)
Whats the difference from Eisenmengers
Syndrome?
http://www.lib.mcg.edu/edu/eshuphysio/program/section4/4ch4/s4ch4_19.htm
Pulmonary
vasculature
Tricuspid
Aortic
Pulmonic Mitral
Resistance arterioles
Pulmonary vascular
resistance falls
Tricuspid
Aortic
Pulmonic Mitral
Resistance arterioles
RV distention LV cavity compressed
and failure (diastole)
Keep HR down
Inhaled O2
Inhaled NO
LA LV High SVR,
Ao
Minimal
RL shunt
PA
RA RV Low
pulmonary
vascular
resistance
Normal, compensated patient with ASD, VSD or PDA-- high SVR and low
pulmonary vascular resistance minimal RL shunt.
Decompensated patient with REAL RL shunt.
LA LV
Decreased
Ao
SVR
desaturation
PA
RA RV Increased
pulmonary
vascular
resistance
desaturation
Decrease in SVR
Increase in CO:
Anesthesiology 2008; 108:80211 Copyright 2008, the
American Society of Anesthesiologists, Inc. Lippincott
Williams & Wilkins, Inc.
Hemodynamic Changes Associated with Spinal
Anesthesia
for Cesarean Delivery in Severe Preeclampsia
Robert A. Dyer, F.C.A. (S.A.),* Jenna L. Piercy, F.C.A.
(S.A.), Anthony R. Reed, F.R.C.A., Carl J. Lombard,
Ph.D.,
What raises pulmonary vascular
resistance?
Alveolar hypoxia
Acidosis
Hypothermia
Crying
Pain (catecholamines)
LR shunts
Volume overload to LV. Can cause CHF.
Can manage with reduction in systemic
vascular resistance (vasodilating
anesthetics).
Over time LR shunt can lead to
Eisenmengers syndrome