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\author{Teas}
\pdfinfo{
  /Title (cardiovascular-disorders.pdf)
  /Creator (Cheatography)
  /Author (Teas)
  /Subject (CARDIOVASCULAR DISORDERS Cheat Sheet)
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\noindent
\begin{multicols}{3}
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    {\parbox{\dimexpr\textwidth-2\fboxsep\relax}{\noindent
        \hspace*{-6pt}\includegraphics[width=5.8cm]{/web/www.cheatography.com/public/images/cheatography_logo.pdf}}
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\begin{tabulary}{11cm}{L}
    \vspace{-2pt}\large{\bf{\textcolor{DarkBackground}{\textrm{CARDIOVASCULAR DISORDERS Cheat Sheet}}}} \\
    \normalsize{by \textcolor{DarkBackground}{Teas} via \textcolor{DarkBackground}{\uline{cheatography.com/181443/cs/37822/}}}
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\noindent
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  \mymulticolumn{2}{p{5.377cm}}{\bf\textcolor{white}{Cheatographer}}  \\
  \vspace{-2pt}Teas \\
  \uline{cheatography.com/teas} \\
  \end{tabulary}
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  \mymulticolumn{1}{p{5.377cm}}{\bf\textcolor{white}{Cheat Sheet}}  \\
   \vspace{-2pt}Not Yet Published.\\
   Updated 21st March, 2023.\\
   Page {\thepage} of \pageref{LastPage}.
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  \vspace{-5pt}
  %\includegraphics[width=48px,height=48px]{dave.jpeg}
  Measure your website readability!\\
  www.readability-score.com
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\begin{multicols*}{3}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{PHYSIOLOGIC CONSIDERATIONS DURING PREGNANCY}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{A. CARDIOVASCULAR PHYSIOLOGY}} \{\{nl\}\} ► Higher rates of obesity, hypertension, and diabetes \{\{nl\}\}  ~ ~ o Half of adults aged 20 and older have at least one risk factor for cardiovascular disease \{\{nl\}\}  ► Another related reason is delayed childbearing} \tn 
% Row Count 6 (+ 6)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{► Cardiac output increases by 30-50, average of 40\% \{\{nl\}\} ~ ~ o 20\% of this total takes place by 8 weeks gestation and is maximal by mid-pregnancy (25-32 weeks) \{\{nl\}\} ~ ~ o Increase heart rate (approx. 10bpm)  \{\{nl\}\} ~ ~ ~ ~  -12-16 weeks AOG   \{\{nl\}\} ~ ~ ~ ~  - 32-36 weeks AOG} \tn 
% Row Count 13 (+ 7)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{► Resting pulse and stroke volume are even higher later in pregnancy \{\{nl\}\}  ► Increase venous pressure within lower extremities comparing upper extremities \{\{nl\}\}  ► Multifetal pregnancies} \tn 
% Row Count 17 (+ 4)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{► After 28 weeks' gestation \{\{nl\}\} ► Heart failure develops peripartum \{nl\}\} nbsp; ~ - Preeclampsia, hemorrhage and anemia, and sepsis} \tn 
% Row Count 20 (+ 3)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{\{\{nl\}\} {\bf{B. VENTRICULAR FUNCTION IN PREGNANCY}}} \tn 
% Row Count 21 (+ 1)
% Row 5
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{►Hemodilution -{}-\textgreater{} increased renin production \{\{nl\}\} ~ ~ -increased end-systolic and end-diastolic dimensions \{\{nl\}\} ► For given filling pressures, there is appropriate cardiac output so that cardiac function during pregnancy is eudynamic   \{\{nl\}\} ~ ~ - Spherical remodelling ―\textgreater{} depressed longitudinal deformation} \tn 
% Row Count 28 (+ 7)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Diagnostic Studies}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{▸ Electrocardiogram (ECG)} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{▸ Radiography} \tn 
% Row Count 2 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{▸ Echocardiography} \tn 
% Row Count 3 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{▸ Cardiovascular MR Imaging} \tn 
% Row Count 4 (+ 1)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{▸ Cardiac catheterization} \tn 
% Row Count 5 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{p{0.4977 cm} p{0.4977 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Classification of Functional Heart Disease}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{5.377cm}}{▸ Class I. Uncompromised} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{2}{x{5.377cm}}{▸ Class II. Slight limitation of physical activity} \tn 
% Row Count 3 (+ 2)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{5.377cm}}{▸ Class III. Marked limitation of physical activity} \tn 
% Row Count 5 (+ 2)
% Row 3
\SetRowColor{white}
\mymulticolumn{2}{x{5.377cm}}{▸ Class IV. Severely compromised} \tn 
% Row Count 6 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Risk Classification of CVD and Pregnancy}}  \tn
\SetRowColor{LightBackground}
\mymulticolumn{1}{p{5.377cm}}{\vspace{1px}\centerline{\includegraphics[width=5.1cm]{/web/www.cheatography.com/public/uploads/teas_1679383769_5.png}}} \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
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\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Risk Classification of CVD and Pregnancy (cont.)}}  \tn
\SetRowColor{LightBackground}
\mymulticolumn{1}{p{5.377cm}}{\vspace{1px}\centerline{\includegraphics[width=5.1cm]{/web/www.cheatography.com/public/uploads/teas_1679383801_6.png}}} \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
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\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{PERIPARTUM MANAGEMENT CONSIDERATIONS}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{▸Women in NYHA class I and most in class II- No morbidity} \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{~ ~ - Avoid contact with persons who have respiratory infections} \tn 
% Row Count 4 (+ 2)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{~ ~ -Cigarette smoking and illicit drug use are prohibited} \tn 
% Row Count 6 (+ 2)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{▸ Women in NYHA class III and IV} \tn 
% Row Count 7 (+ 1)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{~ ~ Prolonged hospitalization and bedrest} \tn 
% Row Count 9 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{LABOR AND DELIVERY}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{▸ Vaginal delivery under epidural anesthesia} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{▸ Indication for Cesarean delivery} \tn 
% Row Count 2 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{~ ~ - dilated aortic root \textgreater{}4 cm or aortic aneurysm;} \tn 
% Row Count 4 (+ 2)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{~ ~ - acute severe congestive heart failure;} \tn 
% Row Count 6 (+ 2)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{~ ~ - recent myocardial infarction;} \tn 
% Row Count 7 (+ 1)
% Row 5
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{~ ~ - severe symptomatic aortic stenosis;} \tn 
% Row Count 9 (+ 2)
% Row 6
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{~ ~ - warfarin administration within 2 weeks of delivery;} \tn 
% Row Count 11 (+ 2)
% Row 7
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{~ ~- need for emergency valve replacement immediately after delivery} \tn 
% Row Count 13 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{ANALGESIA AND ANESTHESIA}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{▸ IV analgesia - Continuous epidural analgesia} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{▸ Women with pulmonary arterial hypertension or aortic stenosis - narcotic regional or general anesthesia} \tn 
% Row Count 4 (+ 3)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{▸ Significant heart disease - Subarachnoid block not generally recommended} \tn 
% Row Count 6 (+ 2)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{▸ Cesarean delivery - epidural analgesia} \tn 
% Row Count 7 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{INTRAPARTUM HEART FAILURE}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{▸ Cardiovascular decompensation during labor may manifest as pulmonary edema with {\bf{hypoxia or as hypotension}}, or both.} \tn 
% Row Count 3 (+ 3)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{~~ -K-sparing diuretics B-blocking agents} \tn 
% Row Count 5 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{p{0.4977 cm} p{0.4977 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{PUERPERIUM}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{5.377cm}}{▸ Decompression —\textgreater{} Intravascular compartment  —\textgreater{}  peripheral vascular resistance —\textgreater{} increased myocardial performance} \tn 
% Row Count 3 (+ 3)
% Row 1
\SetRowColor{white}
\mymulticolumn{2}{x{5.377cm}}{▸ For puerperal tubal sterilization after vaginal delivery, the procedure can be delayed up to several days to ensure that the mother has normalized hemodynamically} \tn 
% Row Count 7 (+ 4)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{p{0.4977 cm} p{0.4977 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{SURGICALLY CORRECTED HEART DISEASE}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{5.377cm}}{Valve replacement before pregnancy} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{2}{x{5.377cm}}{Porcine tissue valves} \tn 
% Row Count 2 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{LIFETIME ANTICOAGULATION (MECHANICAL VALVE)}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{▸ Warfarin - dose given at \textless{}5mg/d} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{▸ Heparin} \tn 
% Row Count 2 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{~ ~ - high maternal mortality} \tn 
% Row Count 3 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{~ ~ - Overdose: Protamine Sulfate} \tn 
% Row Count 4 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{DIAGNOSIS OF HEART DISEASE}}  \tn
\SetRowColor{LightBackground}
\mymulticolumn{1}{p{5.377cm}}{\vspace{1px}\centerline{\includegraphics[width=5.1cm]{/web/www.cheatography.com/public/uploads/teas_1679383460_4.png}}} \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{RECOMMENDATIONS FOR ANTICOAGULATION}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{1. Adjusted-dose LMWH (SC below umbilicus) is given twice daily, given until 13 weeks, and then warfarin is substituted until near delivery and is replaced by Heparin again.} \tn 
% Row Count 4 (+ 4)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{2. In women judged to carry a high risk of thrombosis, warfarin is suggested throughout pregnancy, then Heparin is substituted close to delivery. In addition, aspirin, 75 to 100 mg, is given daily. Heparin is discontinued 24 hrs before delivery. If delivery happens while the anticoagulant is still effective, and extensive bleeding is encountered, then protamine sulfate is given intravenously.} \tn 
% Row Count 12 (+ 8)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{3. Anticoagulant therapy with warfarin or heparin may be restarted 6 hours following vaginal delivery. If CS delivery, full anticoagulation is withheld, resuming heparin 6 to 12 hours or after 24 hours} \tn 
% Row Count 17 (+ 5)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{CARDIAC SURGERY DURING PREGNANCY}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{▸ Valve replacement - lifesaving} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{▸ Elective surgery} \tn 
% Row Count 2 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{~ ~ - Pump flow rate should remain \textgreater{}2.5 L/min/m2} \tn 
% Row Count 4 (+ 2)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{~ ~ - Normothermic perfusion pressure should exceed 70 mm Hg} \tn 
% Row Count 6 (+ 2)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{~ ~ - Hematocrit should be kept \textgreater{}28 volumes percent} \tn 
% Row Count 8 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{PREGNANCY AFTER HEART TRANSPLANTATION}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{▸ Major complications} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{~ ~ - Rejections during the early puerperium} \tn 
% Row Count 3 (+ 2)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{~ ~ - Renal failure} \tn 
% Row Count 4 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{~ ~ - Spontaneous abortions} \tn 
% Row Count 5 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{CONGENITAL HEART DISEASE}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Atrial Septal Defects}}} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{▸ Atrial septal defects (ASDS) - asymptomatic until the third or fourth decade} \tn 
% Row Count 3 (+ 2)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{▸ Secundum-type (70\%)} \tn 
% Row Count 4 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{▸ Pregnant woman with ADS - managed with compression stockings and prophylactic heparin} \tn 
% Row Count 6 (+ 2)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{\{\{nl\}\} {\bf{Ventricular Septal Defects}}} \tn 
% Row Count 7 (+ 1)
% Row 5
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{▸ Paramembranous} \tn 
% Row Count 8 (+ 1)
% Row 6
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{▸ Pregnancy is well tolerated with small-to- moderate sized shunts} \tn 
% Row Count 10 (+ 2)
% Row 7
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{▸ Eisenmenger syndrome - pregnancy not advisable} \tn 
% Row Count 11 (+ 1)
% Row 8
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{▸ 10-16\% - can be inherited} \tn 
% Row Count 12 (+ 1)
% Row 9
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{\{\{nl\}\} {\bf{Atrioventricular Septal Defects}}} \tn 
% Row Count 13 (+ 1)
% Row 10
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{▸ 3\% of all congenital cardiac malformations Complications include} \tn 
% Row Count 15 (+ 2)
% Row 11
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{▸ Complications include} \tn 
% Row Count 16 (+ 1)
% Row 12
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{~ ~ - 23\% persistent deterioration of NYHA class} \tn 
% Row Count 18 (+ 2)
% Row 13
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{~ ~  - 9\% significant arrhythmias} \tn 
% Row Count 19 (+ 1)
% Row 14
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{~ ~ - 2\% heart failure} \tn 
% Row Count 20 (+ 1)
% Row 15
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{▸ Seen in 15\% of the offspring} \tn 
% Row Count 21 (+ 1)
% Row 16
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{\{\{nl\}\} {\bf{Persistent (Patent) Ductus Arteriosus}}} \tn 
% Row Count 22 (+ 1)
% Row 17
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{▸ The ductus connects the proximal left pulmonary artery to the descending aorta just distal to the left subclavian artery} \tn 
% Row Count 25 (+ 3)
% Row 18
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{▸ Prophylaxis for bacterial endocarditis is indicated at deliver} \tn 
% Row Count 27 (+ 2)
% Row 19
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{▸ For unrepaired defects the incidence of inheritance is 4\%} \tn 
% Row Count 29 (+ 2)
% Row 20
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{\{\{nl\}\} {\bf{Cyanotic Heart Disease}}} \tn 
% Row Count 30 (+ 1)
\end{tabularx}
\par\addvspace{1.3em}

\vfill
\columnbreak
\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{CONGENITAL HEART DISEASE (cont)}}  \tn
% Row 21
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{▸ Producing right-to-left shunting of blood past the pulmonary capillary bed and developing cyanosis} \tn 
% Row Count 3 (+ 3)
% Row 22
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{▸ Most common is Tetralogy of Fallot - maternal mortality rate approaches 10\%} \tn 
% Row Count 5 (+ 2)
% Row 23
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{▸ Ebstein anomaly} \tn 
% Row Count 6 (+ 1)
% Row 24
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{\{\{nl\}\} {\bf{Pregnancy after Surgical Repair}}} \tn 
% Row Count 7 (+ 1)
% Row 25
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{▸ Transposition of the Great Vessels} \tn 
% Row Count 8 (+ 1)
% Row 26
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{~ ~ - Prior Mustard and Senning procedure} \tn 
% Row Count 10 (+ 2)
% Row 27
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{▸ Single Functional Ventricle} \tn 
% Row Count 11 (+ 1)
% Row 28
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{~ ~ - Fontan repair - high risk for complications.} \tn 
% Row Count 13 (+ 2)
% Row 29
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{▸ Eisenmenger Syndrome} \tn 
% Row Count 14 (+ 1)
% Row 30
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{~ ~  - Considered to be an absolute contraindication to pregnancy} \tn 
% Row Count 16 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{VALVULAR HEART DISEASE}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Mitral Stenosis secondary to Rheumatic Endocarditis}}} \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{▸ Normal mitral valve - 4.0 cm2; stenosis \textless{}2.5 cm2} \tn 
% Row Count 4 (+ 2)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{▸ Consequences:} \tn 
% Row Count 5 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{~ ~ - passive pulmonary HTN} \tn 
% Row Count 6 (+ 1)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{~ ~  - 25\% of women with mitral stenosis have heart failure for the first time during pregnancy} \tn 
% Row Count 9 (+ 3)
% Row 5
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{~ ~ - pulmonary edema} \tn 
% Row Count 10 (+ 1)
% Row 6
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{▸ Management} \tn 
% Row Count 11 (+ 1)
% Row 7
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{~ ~  - Limited physical activity} \tn 
% Row Count 12 (+ 1)
% Row 8
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{~ ~ - B-blocker drug therapy} \tn 
% Row Count 13 (+ 1)
% Row 9
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{~ ~  - If new-onset atrial fibrillation develops} \tn 
% Row Count 15 (+ 2)
% Row 10
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{~ ~  ~ ~  $\filledsquare{}$ Intravenous verapamil, 5 to 10 mg} \tn 
% Row Count 17 (+ 2)
% Row 11
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{~ ~  ~ ~ $\filledsquare{}$ Electrocardioversion is performed.} \tn 
% Row Count 19 (+ 2)
% Row 12
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{~ ~   - If Chronic fibrillation} \tn 
% Row Count 20 (+ 1)
% Row 13
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{~ ~  ~ ~ $\filledsquare{}$ Digoxin, a B-blocker, or a calcium-channel blocker can slow ventricular response} \tn 
% Row Count 23 (+ 3)
% Row 14
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{▸  Surgical intervention is considered for women with symptomatic severe mitral stenosis: Balloon valvuloplasty} \tn 
% Row Count 26 (+ 3)
% Row 15
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{\{\{nl\}\} {\bf{Mitral Insufficiency}}} \tn 
% Row Count 27 (+ 1)
% Row 16
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{▸  Acute mitral insufficiency} \tn 
% Row Count 28 (+ 1)
% Row 17
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{▸ Chronic mitral regurgitation} \tn 
% Row Count 29 (+ 1)
% Row 18
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{\{\{nl\}\} {\bf{Mitral valve prolapse}}} \tn 
% Row Count 30 (+ 1)
\end{tabularx}
\par\addvspace{1.3em}

\vfill
\columnbreak
\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{VALVULAR HEART DISEASE (cont)}}  \tn
% Row 19
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{▸ Myxomatous degeneration} \tn 
% Row Count 1 (+ 1)
% Row 20
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{▸ B-blockers} \tn 
% Row Count 2 (+ 1)
% Row 21
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{\{\{nl\}\}{\bf{Aortic Stenosis}}} \tn 
% Row Count 3 (+ 1)
% Row 22
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{▸ Congenital lesion: bicuspid valve} \tn 
% Row Count 4 (+ 1)
% Row 23
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{▸ During pregnancy, several common events acutely lower preload further} \tn 
% Row Count 6 (+ 2)
% Row 24
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{▸ Complication rates were higher if the aortic valve area measured} \tn 
% Row Count 8 (+ 2)
% Row 25
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{~ {\emph{Management}}} \tn 
% Row Count 9 (+ 1)
% Row 26
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{▸ Asymptomatic - observation} \tn 
% Row Count 10 (+ 1)
% Row 27
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{▸ Symptomatic:} \tn 
% Row Count 11 (+ 1)
% Row 28
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{~ ~ - Strict limitation of activity and treatment of infections} \tn 
% Row Count 13 (+ 2)
% Row 29
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{~ ~ - Critical aortic stenosis - intensive monitoring during labor is essential} \tn 
% Row Count 15 (+ 2)
% Row 30
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{▸ During labor and delivery, narcotic epidural analgesia seems ideal and avoids potentially hazardous hypotension} \tn 
% Row Count 18 (+ 3)
% Row 31
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{\{\{nl\}\} {\bf{Aortic Insufficiency}}} \tn 
% Row Count 19 (+ 1)
% Row 32
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{▸ Aortic valve regurgitation or insufficiency allows diastolic flow of blood from the aorta back into the left ventricle.} \tn 
% Row Count 22 (+ 3)
% Row 33
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{▸ If symptoms of heart failure develop, diuretics are given and bed rest is encouraged} \tn 
% Row Count 24 (+ 2)
% Row 34
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{\{\{nl\}\} {\bf{Pulmonic Stenosis}}} \tn 
% Row Count 25 (+ 1)
% Row 35
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{▸ Usually congenital} \tn 
% Row Count 26 (+ 1)
% Row 36
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{▸ May be associated with Fallot tetralogy or Noonan syndrome} \tn 
% Row Count 28 (+ 2)
% Row 37
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{▸ Surgical correction done before pregnancy; if symptoms progress - balloon valvuloplasty} \tn 
% Row Count 30 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{PULMONARY HYPERTENSION}}  \tn
\SetRowColor{LightBackground}
\mymulticolumn{1}{p{5.377cm}}{\vspace{1px}\centerline{\includegraphics[width=5.1cm]{/web/www.cheatography.com/public/uploads/teas_1679395616_7.png}}} \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{PULMONARY HYPERTENSION (cont)}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Diagnosis}}} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{▸ Symptoms may be vague} \tn 
% Row Count 2 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{▸ Chest radiography often shows enlarged pulmonary hilar arteries and attenuated peripheral markings} \tn 
% Row Count 5 (+ 3)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{▸ Final common pathway of pulmonary hypertension - right heart failure and death} \tn 
% Row Count 7 (+ 2)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{▸ The maternal mortality rate increased - idiopathic pulmonary hypertension} \tn 
% Row Count 9 (+ 2)
% Row 5
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{\{\{nl\}\} {\bf{Management}}} \tn 
% Row Count 10 (+ 1)
% Row 6
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{▸ Activity limitation} \tn 
% Row Count 11 (+ 1)
% Row 7
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{▸ Diuretics, supplemental oxygen, and pulmonary vasodilator drugs are standard therapy} \tn 
% Row Count 13 (+ 2)
% Row 8
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{▸ Prostacyclin analogues} \tn 
% Row Count 14 (+ 1)
% Row 9
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{▸  Inhaled nitric oxide} \tn 
% Row Count 15 (+ 1)
% Row 10
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{▸ Phosphodiesterase-5 inhibitors} \tn 
% Row Count 16 (+ 1)
% Row 11
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{▸  Bosentan - contraindicated in pregnancy} \tn 
% Row Count 17 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{INFECTIVE ENDOCARDITIS}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{▸ Risk Factors:} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{~ ~ - Congenital heart lesions   Intracardiac devices} \tn 
% Row Count 3 (+ 2)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{~ ~ - Intravenous drug users} \tn 
% Row Count 4 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{~ ~ - Degenerative valve disease} \tn 
% Row Count 5 (+ 1)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{~ ~ - Intracardiac devices} \tn 
% Row Count 6 (+ 1)
% Row 5
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{▸ Diagnosis and Management:} \tn 
% Row Count 7 (+ 1)
% Row 6
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{~ ~ - Fever - 80\%} \tn 
% Row Count 8 (+ 1)
% Row 7
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{~ ~ - Murmur} \tn 
% Row Count 9 (+ 1)
% Row 8
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{~ ~ - Constitutional symptoms} \tn 
% Row Count 10 (+ 1)
% Row 9
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{▸ Duke's criteria:} \tn 
% Row Count 11 (+ 1)
% Row 10
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{~ ~ - Positive blood cultures for typical organisms and evidence of endocardial involvement} \tn 
% Row Count 14 (+ 3)
% Row 11
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{▸ Pregnancy} \tn 
% Row Count 15 (+ 1)
% Row 12
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{▸   The American Heart Association recommends prophylaxis for dental procedures in those with:} \tn 
% Row Count 17 (+ 2)
% Row 13
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{~ ~ - A prosthetic valve used in a valve repair} \tn 
% Row Count 19 (+ 2)
% Row 14
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{~ ~ - Prior endocarditis} \tn 
% Row Count 20 (+ 1)
% Row 15
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{~ ~ -  Unrepaired cyanotic hear defect or repaired lesion with residual defect at prosthetic sites} \tn 
% Row Count 23 (+ 3)
% Row 16
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{~ ~ - Valvulopathy after heart transplantation} \tn 
% Row Count 25 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{INFECTIVE ENDOCARDITIS (cont)}}  \tn
\SetRowColor{LightBackground}
\mymulticolumn{1}{p{5.377cm}}{\vspace{1px}\centerline{\includegraphics[width=5.1cm]{/web/www.cheatography.com/public/uploads/teas_1679397305_8.png}}} \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{HEART FAILURE}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{▸ Risk factors include} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{~ ~ - Preeclampsia} \tn 
% Row Count 2 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{~ ~ - Hemorrhage} \tn 
% Row Count 3 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{~ ~ -  Infection} \tn 
% Row Count 4 (+ 1)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{▸Symptoms} \tn 
% Row Count 5 (+ 1)
% Row 5
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{~ ~ - Dyspnea} \tn 
% Row Count 6 (+ 1)
% Row 6
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{~ ~ - Orthopnea, palpitations,} \tn 
% Row Count 7 (+ 1)
% Row 7
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{~ ~ - substernal chest pain} \tn 
% Row Count 8 (+ 1)
% Row 8
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{▸ Clinical findings include:} \tn 
% Row Count 9 (+ 1)
% Row 9
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{~ ~ - Persistent basilar rales, hemoptysis} \tn 
% Row Count 11 (+ 2)
% Row 10
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{~ ~ - Cardiomegaly and pulmonary edema} \tn 
% Row Count 12 (+ 1)
% Row 11
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{▸Diagnosis} \tn 
% Row Count 13 (+ 1)
% Row 12
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{~ ~ -  Acute flash edema} \tn 
% Row Count 14 (+ 1)
% Row 13
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{~ ~ - Onset: at the end of the second/beginning of the third trimester and peripartum} \tn 
% Row Count 16 (+ 2)
% Row 14
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{▸ Management:} \tn 
% Row Count 17 (+ 1)
% Row 15
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{~ ~ -Diuretic administration} \tn 
% Row Count 18 (+ 1)
% Row 16
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{~ ~ - Hypertension - hydralazine} \tn 
% Row Count 19 (+ 1)
% Row 17
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{~ ~ - Chronic heart failure - Heparin} \tn 
% Row Count 20 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{CARDIOMYOPATHY}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{▸ Primary Cardiomyopathy} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{▸ Secondary Cardiomyopathy} \tn 
% Row Count 2 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{\{\{nl\}\} {\bf{Hypertrophic Cardiomyopathy}}} \tn 
% Row Count 3 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{▸ Hypertrophied and nondilated left ventricle (echocardiography)} \tn 
% Row Count 5 (+ 2)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{▸ Most women are asymptomatic} \tn 
% Row Count 6 (+ 1)
% Row 5
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{▸ Sudden death - most frequent cause of death} \tn 
% Row Count 7 (+ 1)
% Row 6
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{▸ Management:} \tn 
% Row Count 8 (+ 1)
% Row 7
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{~ ~ - Strenuous exercise is prohibited during pregnancy.} \tn 
% Row Count 10 (+ 2)
% Row 8
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{~ ~ - Drugs that evoke diuresis or diminish vascular resistance are generally not used} \tn 
% Row Count 12 (+ 2)
% Row 9
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{\{\{nl\}\} {\bf{Dilated Cardiomyopathy}}} \tn 
% Row Count 13 (+ 1)
% Row 10
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{▸ Characterized by left and/or right ventricular enlargement and reduced systolic function} \tn 
% Row Count 15 (+ 2)
% Row 11
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{\{\{nl\}\} {\bf{Peripartum Cardiomyopathy}}} \tn 
% Row Count 16 (+ 1)
% Row 12
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{▸ Diagnostic criteria:} \tn 
% Row Count 17 (+ 1)
% Row 13
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{~ ~ 1. Development of cardiac failure in the last month of pregnancy or within 5 months after delivery} \tn 
% Row Count 20 (+ 3)
% Row 14
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{~ ~  2. Absence of a cause for the cardiac failure} \tn 
% Row Count 22 (+ 2)
% Row 15
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{~ ~ 3. Absence of recognizable heart disease prior to the last month of pregnancy} \tn 
% Row Count 24 (+ 2)
% Row 16
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{~ ~ 4. Left ventricular systolic dysfunction demonstrated by classic echocardiographic criteria} \tn 
% Row Count 27 (+ 3)
% Row 17
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{▸ Preeclampsia with cardiomyopathy} \tn 
% Row Count 28 (+ 1)
% Row 18
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{~ ~ - Began postpartum} \tn 
% Row Count 29 (+ 1)
% Row 19
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{~ ~ - 50\% recover within 6 months of delivery} \tn 
% Row Count 31 (+ 2)
\end{tabularx}
\par\addvspace{1.3em}

\vfill
\columnbreak
\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{CARDIOMYOPATHY (cont)}}  \tn
% Row 20
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{▸ Preeclampsia with hypertensive heart failure} \tn 
% Row Count 1 (+ 1)
% Row 21
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{~ ~ - Symptoms start antepartum} \tn 
% Row Count 2 (+ 1)
% Row 22
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{~ ~ - Mortality rate approaches 85\%} \tn 
% Row Count 3 (+ 1)
% Row 23
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{\{\{nl\}\} {\bf{Other Cardiomyopathy Types}}} \tn 
% Row Count 4 (+ 1)
% Row 24
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{▸ Arrhythmogenic right ventricular dysplasia} \tn 
% Row Count 5 (+ 1)
% Row 25
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{~ ~ - Progressive replacement of right ventricular myocardium with adipose and fibrous tissue.} \tn 
% Row Count 8 (+ 3)
% Row 26
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{▸ Restrictive cardiomyopathy is probably the least common type} \tn 
% Row Count 10 (+ 2)
% Row 27
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{~ ~ -Inherited cardiomyopathy} \tn 
% Row Count 11 (+ 1)
% Row 28
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{~ ~ - Pregnancy is not advised} \tn 
% Row Count 12 (+ 1)
% Row 29
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{▸ Takotsubo cardiomyopathy} \tn 
% Row Count 13 (+ 1)
% Row 30
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{~ ~ - Rare form of acute reversible left ventricular apical wall ballooning} \tn 
% Row Count 15 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{ARRHYTHMIAS}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Bradyarrhythmias}}} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{▸ Compatible with a successful pregnancy} \tn 
% Row Count 2 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{▸ Some women with complete heart block have syncope during labor and delivery, and occasionally temporary cardiac pacing is necessary} \tn 
% Row Count 5 (+ 3)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{▸ Women with permanent artificial pacemakers usually tolerate pregnancy well} \tn 
% Row Count 7 (+ 2)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{\{\{nl\}\} {\bf{Supraventricular Tachycardias}}} \tn 
% Row Count 8 (+ 1)
% Row 5
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{▸ Paroxysmal supraventricular tachycardia} \tn 
% Row Count 9 (+ 1)
% Row 6
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{~~ -  Twofold greater risk of septal defects} \tn 
% Row Count 11 (+ 2)
% Row 7
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{~~ - Embolic stroke} \tn 
% Row Count 12 (+ 1)
% Row 8
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{▸ For acute treatment, raising vagal tone and blocking the atrioventricular node is done by:} \tn 
% Row Count 14 (+ 2)
% Row 9
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{~~ -Vagal maneuvers, which include Valsalva maneuver} \tn 
% Row Count 16 (+ 2)
% Row 10
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{~~ - Carotid sinus massage, bearing down} \tn 
% Row Count 17 (+ 1)
% Row 11
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{~~ - Immersion of the face in ice water} \tn 
% Row Count 18 (+ 1)
% Row 12
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{~~ - Intravenous adenosine is a short-acting endogenous nucleotide that also blocks atrioventricular nodal conduction.} \tn 
% Row Count 21 (+ 3)
% Row 13
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{▸ Synchronize cardioversion - recommended} \tn 
% Row Count 22 (+ 1)
% Row 14
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{▸ Long term anticoagulation} \tn 
% Row Count 23 (+ 1)
% Row 15
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{~~ - Intravenous metoprolol or propranolol} \tn 
% Row Count 25 (+ 2)
% Row 16
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{~~ - Intravenous verapamil} \tn 
% Row Count 26 (+ 1)
% Row 17
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{~~ - Intravenous procainamide} \tn 
% Row Count 27 (+ 1)
% Row 18
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{~~ -  Intravenous amiodarone} \tn 
% Row Count 28 (+ 1)
% Row 19
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{▸ Pregnancy may predispose otherwise asymptomatic women with Wolff-Parkinson-White (WPW) syndrome to exhibit arrhythmias} \tn 
% Row Count 31 (+ 3)
\end{tabularx}
\par\addvspace{1.3em}

\vfill
\columnbreak
\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{ARRHYTHMIAS (cont)}}  \tn
% Row 20
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{\{\{nl\}\} {\bf{Ventricular Tachycardia}}} \tn 
% Row Count 1 (+ 1)
% Row 21
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{▸ Uncommon in healthy young women without underlying heart disease pregnancy} \tn 
% Row Count 3 (+ 2)
% Row 22
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{▸ Emergency cardioversion} \tn 
% Row Count 4 (+ 1)
% Row 23
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{\{\{nl\}\} {\bf{Prolonged QT-Interval}}} \tn 
% Row Count 5 (+ 1)
% Row 24
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{▸ Torsades de pointes} \tn 
% Row Count 6 (+ 1)
% Row 25
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{▸ B-blocking agents-propranolol} \tn 
% Row Count 7 (+ 1)
% Row 26
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{▸  Many medications may predispose to QT prolongation} \tn 
% Row Count 9 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{DISEASES OF THE AORTA}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Aortic Dissection}}} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{▸ Marfan syndrome and coarctation} \tn 
% Row Count 2 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{▸ Bicuspid aortic valve, Turner or Noonan syndrome and Ehlers- Danlos syndrome} \tn 
% Row Count 4 (+ 2)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{▸ Initial medical treatment - lower blood pressure} \tn 
% Row Count 6 (+ 2)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{▸  Proximal dissections - resected and the aortic valve replaced if necessary} \tn 
% Row Count 8 (+ 2)
% Row 5
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{▸ Distal dissections - may be treated medically} \tn 
% Row Count 9 (+ 1)
% Row 6
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{\{\{nl\}\} {\bf{Marfan Syndrome}}} \tn 
% Row Count 10 (+ 1)
% Row 7
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{▸ Autosomal dominant connective tissue disorder} \tn 
% Row Count 11 (+ 1)
% Row 8
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{▸ 2 to 3 cases per 10,000 individuals} \tn 
% Row Count 12 (+ 1)
% Row 9
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{▸ Characterized by generalized tissue weakness that can result in dangerous cardiovascular complications} \tn 
% Row Count 15 (+ 3)
% Row 10
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{▸ Prophylactic aortic repair Prophylactic ẞ-blocking agents} \tn 
% Row Count 17 (+ 2)
% Row 11
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{▸ Vaginal delivery with regional analgesia - \textless{}4cm} \tn 
% Row Count 19 (+ 2)
% Row 12
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{▸ Elective CS - 4-5cm} \tn 
% Row Count 20 (+ 1)
% Row 13
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{\{\{nl\}\} {\bf{Aortic Coarctation}}} \tn 
% Row Count 21 (+ 1)
% Row 14
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{▸ Relatively rare lesion} \tn 
% Row Count 22 (+ 1)
% Row 15
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{▸ The aorta is abnormally narrowed and is often accompanied by abnormalities of other large arteries} \tn 
% Row Count 25 (+ 3)
% Row 16
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{▸ Typical findings include hypertension in the upper extremities but normal or reduced pressures in the lower extremities.} \tn 
% Row Count 28 (+ 3)
% Row 17
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{▸ Major complications with aortic coarctation include:} \tn 
% Row Count 30 (+ 2)
\end{tabularx}
\par\addvspace{1.3em}

\vfill
\columnbreak
\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{DISEASES OF THE AORTA (cont)}}  \tn
% Row 18
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{~ ~ - Congestive heart failure , and aortic rupture} \tn 
% Row Count 2 (+ 2)
% Row 19
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{~ ~ - Bacterial endocarditis of the bicuspid aortic valve} \tn 
% Row Count 4 (+ 2)
% Row 20
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{▸  B-blocking drugs} \tn 
% Row Count 5 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{ISCHEMIC HEART DISEASE}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Myocardial Infarction During Pregnancy}}} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{▸ Mortality rate in pregnancy is higher compared with age- matched nonpregnant women} \tn 
% Row Count 3 (+ 2)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{▸ Coronary angiography - diagnostic gold standard} \tn 
% Row Count 5 (+ 2)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{▸ Myocardial ischemia is also associated with prostaglandin E1 vaginal suppositories given for labor induction} \tn 
% Row Count 8 (+ 3)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{▸ Treatment} \tn 
% Row Count 9 (+ 1)
% Row 5
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{~ ~ - Percutaneous transluminal coronary angioplasty and stent placement during pregnancy is successful} \tn 
% Row Count 12 (+ 3)
% Row 6
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{~ ~ - If the infarct has healed sufficiently, cesarean delivery is reserved for obstetrical indications, and epidural analgesia is ideal for labor} \tn 
% Row Count 16 (+ 4)
% Row 7
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{\{\{nl\}\} {\bf{Pregnancy with Prior Ischemic Heart Disease}}} \tn 
% Row Count 18 (+ 2)
% Row 8
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{▸  Pregnancy in most of these women seems inadvisable} \tn 
% Row Count 20 (+ 2)
% Row 9
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{~ ~ - Ventricular performance should be assessed} \tn 
% Row Count 22 (+ 2)
% Row 10
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{~ ~ - For those who become pregnant before these studies are performed, echocardiography is done.} \tn 
% Row Count 25 (+ 3)
% Row 11
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{~ ~ - Exercise tolerance testing may be indicated, and radionuclide ventriculography exposes the fetus to minimal radiation} \tn 
% Row Count 28 (+ 3)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}


% That's all folks
\end{multicols*}

\end{document}