Assessment and evaluation of the woman with cardiac disease during pregnancy

Maternal heart disease complicates 0.2 to 3% of pregnancies and is responsible for 10% to 25% of maternal deaths. Many healthy women manifest subtle signs of cardiac failure during uncomplicated pregnancy and birth. Classic symptoms of heart disease mimic common symptoms of late pregnancy, such as palpitations, shortness of breath with exertion, and occasional chest pain. A complete cardiovascular examination assists the healthcare team to fully assess and evaluate the pregnant woman with known heart disease. Detailed assessment of the woman throughout pregnancy may lead to initial discovery of heart disease. Compilation of these objective data with subjective functional capacities allows for risk stratification and assignment to a New York Heart Association functional classification.

Peripheral pulmonary stenosis murmurs

QUESTION:WHAT IS A PERIPHERAL PULMONARY stenosis (PPS) murmur, and why is it so common in premature infants?

The innocent heart murmur in children

Most children have an audible murmur at some point from infancy through adolescence. Fortunately most of these murmurs are innocent. These murmurs are asymptomatic and require no follow-up care. On the other hand, pathologic murmurs are symptomatic and do require assessment by a pediatric cardiologist. Referrals are not only anxiety-provoking for the family but are also costly. The pediatric nurse practitioner must therefore be able to differentiate between the innocent and pathologic murmur. Auscultation of heart sounds is the most effective method used to assess murmurs. Given that innocent murmurs are asymptomatic, they require minimal follow-up care, and the expected outcome for a child with the diagnosis of such a murmur is excellent.