Question

All of the following are cardiac contraindications to pregnancy, except:

• A. Eisenmenger's syndrome
• B. Pulmonary hypertension
• C. Coarctation of aorta
• D. WPW syndrome

Hint:

Three options fix or strain cardiac output; one is just an arrhythmia.

Answer 1

The Correct Option is D

Step 1: The question asks which condition is NOT a contraindication to pregnancy. Pregnancy nearly doubles cardiac output and plasma volume, so lesions that fix or limit cardiac output, or that depend on a delicate pressure balance, become dangerous.
Step 2: Eisenmenger's syndrome carries a maternal mortality of about 30 to 50 percent. The fall in systemic vascular resistance during pregnancy worsens the right-to-left shunt and causes hypoxia. It is an absolute contraindication.
Step 3: Severe pulmonary hypertension (pulmonary artery pressure > two-thirds systemic) is one of the highest-risk states, with maternal mortality of 30 to 50 percent. The fixed pulmonary circulation cannot accommodate the increased volume load. Absolute contraindication.
Step 4: Coarctation of aorta, especially uncorrected with associated aneurysm, risks aortic dissection and rupture during the haemodynamic stress of pregnancy, so it is also regarded as a contraindication.
Step 5: Wolff-Parkinson-White (WPW) syndrome is a pre-excitation arrhythmia from an accessory pathway. It is managed with drugs or ablation and does not impose a fixed haemodynamic limit. It is not a contraindication to pregnancy.
Hence the exception is WPW syndrome, option D.