M2C_Cardiac Disorders

• Rheumatic fever is a direct concern for pregnant women with heart disease
• Pregnant women with heart disease have decreased cardiac reserve, making it difficult for them to accommodate the higher workload during pregnancy
• During pregnancy, there is an increase in blood volume to more than 1 L, leading to increased cardiac output and heart rate
• At 28-32 weeks of gestation, there is a peak in cardiovascular changes with an increase in cardiac output to 25-50% and heart rate to 80-90 bpm
• Iron needs increase to 800 mg daily during pregnancy
• Cardiac disorders include:

  • Congenital Heart Defects: Tetralogy of Fallot, atrial septal defect, ventricular septal defect, patent ductus arteriosus, coarctation of the aorta
  • Rheumatic Heart Disease: Mitral Valve Stenosis caused by rheumatic fever
  • Marfan Syndrome: Dissection rupture of the aorta, autosomal dominant disorder
  • Eisenmenger Syndrome: Left to right shunting, development of pulmonary hypertension
• Classification of heart disease:

  I. Uncompromised: No limitations in physical activities, no symptoms of cardiac insufficiency

  II. Slightly compromised: Slight limitations, discomfort with physical activity

  III. Markedly compromised: Marked limitations in physical activities, can complete pregnancy with special preventions

  IV. Severely compromised: Failure to carry on physical activities, advised to avoid pregnancy
• Assessment includes:

  • Fatigue
  • Cough frequency and productivity
  • Tachycardia
  • Tachypnea
  • Poor fetal heart tone
  • Edema, which can progress to anasarca
  • Decreased amniotic fluid from intrauterine growth restriction
• Effects to the mother:

  • Left side heart failure: Pulmonary hypertension, pulmonary edema, orthopnea
  • Right side heart failure: Distended jugular vein, hepatomegaly, ascites, peripheral edema
• Effects to the fetus from left side heart failure:

  • Low birth weight
  • Intrauterine growth restriction
  • Abortion
  • Stillbirth
  • Early delivery/preterm birth
• Medical management (BAADD):

  1. Digoxin: Slows ventricular response, increases myocardial contractility

  2. Diuretics: Reduces blood volume

  3. Beta-adrenergic blockers (Propranolol): Decreases strain on the aorta, decreases blood pressure

  4. Aminophylline: Relieves bronchospasm

  5. Anticoagulants (low-molecular weight heparin): Prevents thrombus formation
• Nursing management:

  • Encourage rest periods, left side lying to prevent supine hypotension
  • Promote healthy nutrition
  • Emphasize importance of medication adherence
  • Educate on infection prevention
  • Be prepared for emergency actions