Cardiology>>>>>Heart Failure
Question 23#

A 42-year-old Caucasian woman presents to the outpatient clinic when she is 10 weeks pregnant. This is her second pregnancy and was unplanned. Her first pregnancy was complicated by peripartum cardiomyopathy with moderate impairment of left ventricular systolic function. However, she did have complete resolution of systolic function 6 months after the birth of her first child.

Which one of the following statements is true?

A. Her risk of death during this pregnancy is significantly increased
B. Her risk of developing heart failure during the pregnancy is around 20%
C. If she develops cardiomyopathy during this pregnancy, the likelihood of resolution of LV function after pregnancy is high
D. Prophylactic use of ACE inhibitors is mandatory
E. Early detection of heart failure by clinical examination during the pregnancy will be sufficiently sensitive to detect deteriorating LV function

Correct Answer is B

Comment:

Patients with previous peripartum cardiomyopathy with complete resolution of LV function have a low mortality risk in subsequent pregnancies. The risk of re-developing the cardiomyopathy is higher, with 20% presenting with heart failure with a reduction in the likelihood of resolution of LV function. ACE inhibitors are contraindicated in the first trimester of pregnancy. Examination findings in preganancy can be very misleading as systolic murmurs, third heart sound, and ankle oedema can be detected in normal pregnancy.