Monika Sanghavi MD Profile picture
Sep 13, 2018 12 tweets 9 min read Twitter logo Read on Twitter
#FITSurvivalGuide: CV disease in Pregnancy #CardioObstetrics

#Tweetorial for new #CardiologyFIT by @MonSangh and @JennLewey @Penn

1⃣CV Physiology
2⃣Peripartum CM
4⃣Valve Dz
7⃣HTN Disorders of 🤰
8⃣🤰& Future CV Risk
9⃣Drug Safety
1⃣CV Physiology

**Major changes occur to meet metabolic & circulatory needs of 🚼.

🔸Hemodynamic: ⬇️SVR/BP ⬆️HR/CO ⬆️Plasma ↔️Filling pressure
🔸Structural: ⬆️Chamber/LV mass ⬆️Aortic Compliance
🔸Cardiometabolic: ⬆️Insulin resistance ⬆️Lipid/Trig
2⃣Peripartum Cardiomyopathy

🔸Epi: Blacks>>White
🔸Cause: Double-hit hypothesis
🔸Dx: Idiopathic, EF < 45%, ~ 1 m prior or 5 m after delivery
🔸Rx: HF tx; metoprolol/enalapril safe for lactation; ?bromocriptine, ?lactation
🔸LVEF recovery 👍 future risk
3⃣Spontaneous Coronary Artery Dissection (SCAD )
#SCAD -> AMI in 3rd tri & postpartum (most common cause)

🔸Get EKG & Tn in P & PP 👩‍🦰 with CP
🔸Dx made by cath
🔸Conservative tx (meds>>PCI)
🔸?prolonged IP obs
🔸Strong association with FMD
4⃣Valve Disease

🔸Regurg better tolerated than stenosis in 🤰
🔸Mitral Stenosis: ­ CO ↑ ­ MV gradient ↑ -> HF sx
▪️Tx: BB, Lasix, PMBV if refractory
🔸 Mech valves: (Controversy; ?Dose)
▪️2-3 Tri: Warfarin
▪️1 Tri: Warfarin vs Lovenox

🔸High-risk for 🤰with aortic pathology, high mortality.
🔸Vascular Ehlers-Danlos pregnancy 🙅‍♀️
🔸Monitor with echo, MRI (q 4-12 weeks)
🔸Strict BP control (BB -> monitor fetal growth)
🔸Delivery: Continue BB, CS if (Ao >45mm, Acute/Chronic Dissection
6⃣Arrhythmias in Pregnancy
🔸2/2 hemodynamic, hormonal, & autonomic changes
🔸Ectopy > AF and PSVT > VT/VF
🔸Tx (Similar):adenosine, bb, then antiarrhythmics
🔸Defer ablation 2nd tri if possible
🔸DCCV safe during entire pregnancy (monitor fetus)…
7⃣HTN Disorders of 🤰
🔸5-10% of pregnancies
🔸Diagnosis (see below)
🔸Tx: methyldopa, nifedipine, and/or labetalol during pregnancy
*C-htn: ?If SBP >160 (CHAPS study)
*Preeclampsia: Deliver
🔸ASA 1st Tri for preeclampsia prevention…
8⃣🤰& Future CV Risk
Pregnancy is "nature's stress test"
🔸Complications associated w/ ⬆️ risk of CVD (?predicts vs. causes)
- G-DM
- Preterm
- Small baby
🔸Recurrent/multiple complications ⬆️risk
🔸Important to take pregnancy hx!
9⃣Drug Safety in Pregnancy

🔸Meds to avoid: ACEI, ARB, statin, amio
🔸Coumadin ok w/ mech valves (see above)
🔸A, B, C, D risk categories no longer preferred
🔸Consider Risks/Benefits

Websites:… (Table 7)
🔸That's a wrap! This is just the basics.
🔸Encourage comments/discussion.
🔸Follow hashtag #CardioObstretrics for updates

• • •

Missing some Tweet in this thread? You can try to force a refresh

Keep Current with Monika Sanghavi MD

Monika Sanghavi MD Profile picture

Stay in touch and get notified when new unrolls are available from this author!

Read all threads

This Thread may be Removed Anytime!


Twitter may remove this content at anytime! Save it as PDF for later use!

Try unrolling a thread yourself!

how to unroll video
  1. Follow @ThreadReaderApp to mention us!

  2. From a Twitter thread mention us with a keyword "unroll"
@threadreaderapp unroll

Practice here first or read more on our help page!

Did Thread Reader help you today?

Support us! We are indie developers!

This site is made by just two indie developers on a laptop doing marketing, support and development! Read more about the story.

Become a Premium Member ($3/month or $30/year) and get exclusive features!

Become Premium

Don't want to be a Premium member but still want to support us?

Make a small donation by buying us coffee ($5) or help with server cost ($10)

Donate via Paypal

Or Donate anonymously using crypto!


0xfe58350B80634f60Fa6Dc149a72b4DFbc17D341E copy


3ATGMxNzCUFzxpMCHL5sWSt4DVtS8UqXpi copy

Thank you for your support!

Follow Us on Twitter!