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← Section VI · Miscellaneous Topics (Role of Echo)
VI.I

Pregnancy

5 cards

Notes

Normal pregnancy hemodynamics

  • Cardiac output ↑ 30–50 % by mid-pregnancy (mainly stroke volume + HR).
  • Blood volume ↑ 40–50 % (dilutional anemia).
  • Systemic vascular resistance ↓ (progesterone-mediated vasodilation).
  • Physiologic MR (mild), TR, PR common on echo - annular dilation from volume load.
  • Mild chamber dilation.
  • BP low in 2nd trimester, rises in 3rd trimester.

Normal echo findings in pregnancy

  • Increased LV EDV.
  • Trace-to-mild MR and TR from annular dilation.
  • Slightly increased LV wall thickness.
  • Mildly increased pulmonary artery pressures.
  • Preserved EF (though ejection may look slightly reduced due to volume loading).

High-risk cardiac conditions in pregnancy (WHO IV - pregnancy contraindicated)

  • Severe pulmonary hypertension / Eisenmenger syndrome.
  • Severe systemic ventricular dysfunction (EF < 30 %, NYHA III–IV).
  • Previous peripartum cardiomyopathy with any residual LV impairment.
  • Severe symptomatic aortic stenosis.
  • Severe mitral stenosis (poorly tolerated even if asymptomatic pre-pregnancy).
  • Marfan with aortic root > 45 mm.
  • Loeys-Dietz aortopathy.
  • Native severe coarctation.

Peripartum cardiomyopathy

  • LV EF < 45 % onset in late pregnancy through ~ 5 months postpartum.
  • No other identifiable cause.
  • May recover; recurrence risk with future pregnancies.

Mitral stenosis in pregnancy

  • Poorly tolerated as CO and HR rise.
  • Percutaneous balloon mitral valvuloplasty is the treatment of choice for symptomatic MS with favorable morphology.

Aortic dissection in pregnancy

  • Increased risk in Marfan, Loeys-Dietz, bicuspid AV, and postpartum HTN.
  • Elective surgery for aortic root > 40 mm in Marfan (some experts) or > 45 mm (others) before pregnancy.

Cards

  • basicVI.I-001
    By what percentage does cardiac output typically increase during a normal pregnancy?
    → 30–50%. Peaks around 20–24 weeks and returns to baseline several weeks postpartum. Driven mainly by increased stroke volume and modestly increased heart rate.
  • basicVI.I-002
    Define peripartum cardiomyopathy.
    → New-onset LV systolic dysfunction (EF < 45%) presenting in late pregnancy (last month) through approximately 5 months postpartum, with no other identifiable cause of heart failure.
  • basicVI.I-003
    Why is symptomatic mitral stenosis poorly tolerated in pregnancy, and how is it managed?
    → Pregnancy raises cardiac output, HR, and blood volume — all of which raise transmitral gradient. Symptomatic patients with favorable morphology should undergo percutaneous balloon mitral valvuloplasty during pregnancy.
  • basicVI.I-004
    List three high-risk cardiac conditions in which pregnancy is contraindicated (WHO IV).
    → 1) Eisenmenger syndrome / severe pulmonary hypertension. 2) Severe systemic LV dysfunction (EF < 30% or NYHA III–IV). 3) Marfan with aortic root > 45 mm. Also severe symptomatic AS, severe MS, previous peripartum CM with residual dysfunction, native severe coarctation.
  • basicVI.I-005
    Which mild valvular regurgitations are physiologic in pregnancy?
    → Trace-to-mild mitral, tricuspid, and pulmonic regurgitation from annular dilation due to volume load. Should not be interpreted as new pathologic disease.