Cardiac disease in pregnancy physical examination

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Cardiac disease in pregnancy Microchapters

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Overview

Pathophysiology

Epidemiology and Demographics

Risk Factors

Diagnosis

History and Symptoms

Physical Examination

Electrocardiogram

Exercise Testing

Radiation Exposure

Chest X Ray

Echocardiography

MRI

CT

Catheterization:

Pulmonary artery catheterization
Cardiac catheterization
Cardiac Ablation

Treatment

Cardiovascular Drugs in Pregnancy

Labor and delivery

Resuscitation in Late Pregnancy

Contraindications to pregnancy

Special Scenarios:

I. Pre-existing Cardiac Disease:
Congenital Heart Disease
Repaired Congenital Heart Disease
Pulmonary Hypertension
Rheumatic Heart Disease
Connective Tissue Disorders
II. Valvular Heart Disease:
Mitral Stenosis
Mitral Regurgitation
Aortic Insufficiency
Aortic Stenosis
Mechanical Prosthetic Valves
Tissue Prosthetic Valves
III. Cardiomyopathy:
Dilated Cardiomyopathy
Hypertrophic Cardiomyopathy
Peripartum Cardiomyopathy
IV. Cardiac diseases that may develop During Pregnancy:
Arrhythmias
Acute Myocardial Infarction
Hypertension

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]; Lakshmi Gopalakrishnan, M.B.B.S. [3]

Overview

Normal physical exam signs of pregnancy include an "innocent" systolic flow murmur in 96% of patients due to the hyperdaynamic circulation, a diastolic murmur in 18% of patients, jugular venous distension and a displaced cardiac apex due to volume expansion, an S3 in 84% of patients, an occasional S4, varicose veins and pedal edema.

Physical Examination

Vitals

Neck

  • The carotid upstroke is brisk due to the volume expansion and hyperdynamic state
  • Jugular venous distension may be present due to the volume expansion

Heart

Heart Sounds:

  • Increased intensity of the first heart sound secondary to physiologic hyperdynamic circulation during pregnancy
  • An S4 is occasionally heard
  • An S3 is heard in 84% of cases

Murmur:

  • In general there are often innocent murmurs of pregnancy. These are the result of a hyperkinetic circulation. These murmurs are usually midsystolic and soft and heard best at the left lower sternal border and over the pulmonic area.
  • A systolic murmur is heard in 96% of patients, and a diastolic murmur is heard in 18% of patients.
  • Pulmonic midsystolic murmur
  • Continuous murmur (mammary soufflé, cervical hum)

Lungs

  • Adventitious sounds such as basal rales may be appreciated

Extremities

References


Cardiology