Which of the following is seen in pregnancy with heart disease, which is not seen in normal pregnancy?(AIIMS November 2013, Nov 2012}
Ans. a. Distended neck veins (Ref: Dutta 7/e p50, 51, 52, 53, 55: Williams Obstetrics 22/e p1019)Distended neck veins are seen in pregnancy with heart disease, but not seen in normal pregnancy.'Supine hypotension is found during late pregnancy, the gravid uterus produces the compression effect on the IVC, when the patient is supine. This, however, results in opening of the collateral circulation by means of paravertebral azygous vein. In some cases (10%), when the collateral circulation fails to open up, the venous return of the heart may be seriously curtailed. This results in production of hypotension.' - Dutta 7/e p53A state of hyperventilation occurs during pregnancy leading to increase in tidal volume and therefore respiratory minute volume by 40%. It is probably due to progesterone acting on the respiratory centre and also to increase in sensitivity of the centre to carbon dioxide. The woman feels shortness of breath.'- Dutta 7/e p55'The increased accumulation of fluid in the tissue spaces mainly below the uterus is due to:1. Diminished colloid osmotic tension due to hemodilution driving the fluid out of the vessel2. Increased venous pressure of the inferior extremities. Thus slight edema of the legs is not uncommon, in otherwise normal pregnancy .'- Dutta 7/e p50.Clinical Indicators of Heart Disease During PregnancySymptomsSigns* Severe progressive dyspnea (MC symptom)Q* Syncope with exertionQ* Progressive orthopneaQ* Paroxysmal nocturnal dyspnea* Persistent neck vein distentionQ* Systolic murmur >3/6 gradeQ* Diastolic murmurQ* CardiomegalyQ* Sustained arrhythmia* Persistent split 2nd heart sound, low P2* Clubbing and cyanosisQAnatomical changes in CVS during PregnancyHeart is pushed upward and outward, with slight rotation to the left.Hemodynamic Changes during Pregnancy Non-PregnantPregnancy near TermChangeCardiac output (litre/min)4.56.26+40%Stroke volume (ml)6575+27%Heart rate (per minute)7085+17%Blood pressureUnaffected or mid-pregnancy drop of diastolic pressure by 5-10 mm HgVenous pressure8-10 cm (femoral)20 cm water+100% waterColloid oncotic pressure2018-14%Systemic vascular resistance -21%Pulmonary vascular resistance -34%
Distended neck veins
Exertional dyspnea
Pedal edema
Supine hypotension
Cardiovascular Disorders