Perioperative Medicine Web-Based Curriculum & Reference

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PERIOPERATIVE MEDICINE

Web-Based Curriculum & Reference

Editors

Kurt J. Pfeifer, MD, FACP

Steven L. Cohn, MD, FACP

Medical College of Wisconsin

State University of New York - Downstate

Pregnancy

Michael P. Carson, MD & David A. Halle, MD

	Cardiovascular Changes of Pregnancy
	Rapid rise and quick collapse of peripheral pulses. More prominent jugular A and V waves. Point of maximal impulse (PMI) shifts laterally and cephalad. Venous hum may be heard over the sternum. Holosystolic murmur may be heard over bilateral breasts late in pregnancy (mammary souffle).


TYPICAL MURMUR OF PREGNANCY
Present in 96% of pregnant women. Grade I-II early systolic murmur due to increased blood flow through pulmonary artery. Becomes quieter with inspiration.
OTHER CV EXAM FINDINGS OF PREGNANCY
Nonsustained S3 may be heard. Pre-existing murmurs typically increase in intensity due to increased cardiac output and blood volume. 1/3 of women will have lower extremity edema.
ATYPICAL FINDINGS
Changes in edema may suggest preeclampsia if sudden, or venous thrombosis if asymmetric. Facial or hand edema. Diastolic murmurs Sustained S3 or S4.