04.03 Cardiac (Heart) Disease

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Cardiovascular Changes in Pregnancy (Image)

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In this lesson I will explain cardiac disease in a pregnancy and your role in caring for this type of patient.

Let’s look at cardiac disease and why it is a problem in pregnancy. Pregnancy puts an increased workload on the heart because there is extra volume and then there is also increased weight that increases the work on the heart so this is even more of a problem for a patient that already has a not so good heart. Now let’s look at the heart. The heart is a pump and it is not able to pump effectively if there is cardiac disease. So the pump will be working harder in pregnancy to move the extra volume and get healthy blood flow through the placenta and to the fetus.

Some concerning cardiac issues can include heart valve replacements, marfan syndrome, cardiomyopathy, pulmonary HTN, congenital heart issue, and heart failure. Of course these are not all of them but a few examples that could lead to extra workload on the heart. Even women with no cardiac diseases can develop a problem in pregnancy because the heart can’t keep up with the extra weight and or volume.

For assessment we always need a baseline. So a baseline assessment of hemodynamics for mom and fetus is important. We need to auscultate heart and lung sounds. If there is any abnormality it needs to be noted. It is important to be aware that murmurs can be a normal finding in pregnancy because of the extra blood volume. If there is any pain or discomfort with normal activity it needs to be noted and reported.

For management we need to treat the disease, Whatever cardiac disease it is we need to manage with whatever is specific for the disease. If fluid overload is a piece of the problem we can give diuretics to decrease the preload. In this picture you can see how if there is an increase in preload, the blood coming into the heart, it is going to add increased work on the heart and if the heart is already diseased it will be even harder for the “pump” to pump.

Perfusion, oxygenation and fluid & electrolytes are the concepts. We need good perfusion to get to the blood and oxygen to the tissues and fetus. Fluid and electrolytes are important to manage and balance with cardiac disease.

For education we need to educate on appropriate weight gain. We do not want a cardiac patient to gain too much weight because this will add extra work to heart. If a patient is already overweight or obese this will put the patient at an even greater risk. A healthy diet should be instructed so the patient stays at a healthy weight and a diet low in sodium is important. Patients should also know signs to report such as a sudden increase in edema, shortness of breath, decreased fetal movement, and extreme tiredness.
Our key points to bring it all together are that in pregnancy there is an increased workload on the heart so the pump can get tired. The pump is also broken, it is not working at 100%. Pregnancy makes it even harder to manage the disease because of the pump being tired. Perfusion is the last key point. Not only do we need to perfuse the body as usual but also a placenta to get nutrients to the fetus. This is essential for healthy growth of the fetus. If our pump isn’t effective the perfusion to the body and placenta won’t be effective.

Make sure you check out the resources attached to this lesson and review different management of the various cardiac diseases. Now, go out and be your best selves today. And, as always, happy nursing.
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