Professional Documents
Culture Documents
Cardiovascular Disease in Obstetrics
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
home.cc.umanitoba.ca/~soninr/PS.ht
www.med.yale.edu/.../cardio/chd/e_a
ml
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-
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
Eisenmenger’s 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/po
p/23jfig.htm
tchin.org/portraits/angela-1.htm
Pulmonary Hypertension (PH)
• What’s the difference from Eisenmenger’s
Syndrome?
http://www.lib.mcg.edu/edu/eshuphysio/program/section4/4ch4/s4ch4_19.htm
http://www.pathguy.com/lectures/hipbp.gif
Pulmonary hypertension
• Acute pulmonary thromboembolism
Pulmonary hypertension
• Chronic pulmonary thromboembolism
Pulmonary hypertension develops
when pulmonary arteries develop
abnormal resistance
• 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
Ao Decreased
SVR
desaturation
PA
RA RV Increased
pulmonary
vascular
resistance
desaturation
Decrease in SVR
Increase in CO:
Anesthesiology 2008; 108:802–11 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
Eisenmenger’s syndrome