Incorrect. Some things are done differently in reproductive technology in women with cardiovascular disease. Superovulation is a pro-thrombotic situation, therefore every woman embarking on a fertility treatment should have an individual risk assessment for venous thromboembolism. Transferring only a single embryo is also recommended in women with cardiovascular disease as carrying multiple gestations is associated with higher risk.

Incorrect. Should there be any risk of thromboembolic events, progestin-only treatment, contraceptive implants and/or levonorgestrel IUD should be considered.

Correct. It is recommended that termination of pregnancy should be discussed with women classified as high risk in cardiovascular disease due to elevated risk of maternal and fetal mortality and severe morbidity. Efforts should also be made to minimize delays for women seeking a termination as risk of procedure-related complications rises as gestational age increases.

Correct. This counselling should be provided by an appropriately trained healthcare professional within a multidisciplinary team. This team should be able to offer psychological support and education to encourage decision-making.

Incorrect. Management with antiarrhythmic medication - beta-blockers, sotalol and flecainide is sufficient, an ICD implantation is recommended only in high-risk women.

Incorrect. Disopyramide may cause uterine contractions and is not recommended in pregnancy unless benefits outweigh foetal risks. Myosin inhibitors are not recommended in pregnant women due to lack of safety data.

Correct. Beta-blockers may be used as rate control medication, with verapamil being the second drug of choice.

Correct. In hypertrophic cardiomyopathy and severe LVOT obstruction, peripheral vasodilatation is poorly tolerated.

Incorrect. Anti-emetic medications are contraindicated as primary therapy, because they are QT-prolonging. Women with LQTS should be promptly treated for hypokalemia and hypomagnesemia in pregnancy-related hyperemesis. ECG monitoring should be performed if anti-emetic therapy is absolutely required.

Incorrect. It is true that long QT syndrome can manifest very early in life, even during the fetal period. However it is important to perform neonatal ECG post-delivery and after 2 weeks to avoid overdiagnosis due to transiently prolonged QT during the first 7-10 days of life.

Correct. Beta-blocker therapy was associated with risk reduction in all the studies. They should also be continued in the post-partum period.

Incorrect. Symptomatic management is important - avoiding contraindicated medication (brugadadrugs.org), large meals, excess alcohol and promptly treating fever and its causes. However if there are symptoms during pregnancy, quinidine therapy should be considered with monitoring of hepatic function and blood count in the mother.

Correct. Quinidine therapy should be continued during pregnancy and post-partum period.

Incorrect. Beta-blockers are the mainstay of therapy - nadolol and propranolol, with additive flecainide if needed. Left cardiac sympathetic denervation is a valuable anti-arrhythmic option that should be performed in experienced centres before pregnancy if indicated.

Correct. Propofol and local anaesthetics with sodium-blocking agents (lidocaine) carry a theoretical risk of triggering arrhythmias in women with Brugada syndrome.

Incorrect. Neuraxial anaesthesia reduces pain and therefore adrenergic activation which is specifically important in long QT syndrome and catecholaminergic polymorphic ventricular tachycardia.

Incorrect. Peripartum cardiomyopathy may present itself with subtle manifestations, but most women present with acute heart failure with severe symptoms (NYHA III/IV). Mild to moderate symptoms can be mistaken for physiological changes associated with pregnancy.

Correct. Contraindicated medications include e.g. ACE-Is, ARBs, MRAs, SGLT2 inhibitors.

Incorrect. Bromocriptine as a prolactine suppressant may be considered alongside standard heart failure treatment. Therapy of peripartum cardiomyopathy doesn’t involve bromocriptine alone.

Correct. PPCM may cause ventricular tachyarrhythmias and patients should therefore be monitored. Wearable cardioverter defibrillators for pregnant women with LVEF < 35% can be a bridge to recovery, as about half of the women with PPCM recover within 1 year.

Incorrect. Acute aortic dissection typically occurs post-partally and the exact mechanism is unclear. However given the high post-partum prevalence, haemodynamic changes do not fully explain the increased risk and hormonal influences are likely involved.

Incorrect. Celiprolol is the correct treatment that should be administered even in normotensive women. Planned C-section at 37 weeks is also recommended.

Correct. The risk of cardiovascular manifestations is about 1 in 2. Higher rates of adverse events during pregnancy and post-partum have also been reported including hypertension, gestational diabetes, haemorrhage, etc.

Incorrect. Strict blood pressure control is recommended in all women with aortic disease. Specific target values have not been studied - in the general population it is recommended that treated systolic BP values be targeted to 120-129 mmHg to reduce cardiovascular disease provided the treatment is well tolerated.

Correct. These women should be monitored with echocardiography during pregnancy and up to 6 months post-partum in intervals based on their individual risk. CMR without gadolinium of the entire aorta is recommended in pregnant women who haven’t had CT or CMR prior to pregnancy.

Correct. It is important to continue fetal growth monitoring while on beta-blockers, as they seem to be able to cause lower body weight in infants.

Correct. If the maximum aortic diameter is above 45mm, C-section is recommended.

Incorrect. Delivery before cardiac surgery should be considered as soon as the fetus is viable, taking gestational age, comorbidities and other factors into account. Cardiac surgery during pregnancy may be considered if other methods have failed and in situations that threaten the mother’s life.

Correct. This also means optimizing medical therapy and healthy lifestyle choices.

Incorrect. In general, vaginal delivery is the preferred delivery mode in women with adult congenital heart disease. However the timing and mode of delivery should ultimately be decided by the Pregnancy Heart Team.

Correct. It is necessary to discuss the increased transmission risk of the disease. Pre-pregnancy evaluation should be managed by the Pregnancy Heart Team.

Incorrect. Most women with congenital heart disease have a relatively favourable pregnancy outcome. General mortality rates including severe complications like heart failure or arrhythmias have improved. However, this also depends on the severity of the disease.

Correct. They should also be educated at the time of diagnosis about the high risks and uncertainties of becoming pregnant, with referral for psychological support if needed.

Incorrect. C-section may be preferred over vaginal delivery due to better control of the process. Regional anesthesia is usually favoured over general anesthesia.

Correct. It can be performed to assist management in women showing deterioration.

Correct. Endothelin receptor antagonists, riociguat and selexipag should be stopped because of potential or unknown teratogenicity. Women with heart failure may require treatment with diuretics, iron deficiency should also be treated.

Correct. Fondaparinux may be considered as an alternative.

Incorrect. In haemodynamically stable pregnant women with suspicion of pulmonary embolism, the diagnostic approach aims to reduce the need for CTPA by using clinical features, D-dimer and venous ultrasound. It’s true that D-dimers increase during pregnancy, but we can use adapted D-dimer thresholds for diagnosis.

Incorrect. In all pregnant women in high suspicion of VTE, anticoagulation with therapeutic LMWH should be started immediately, even before imaging, until the diagnosis of VTE is either excluded or confirmed.

Incorrect. It should be administered for a minimum of 6 weeks up to an overall duration of 3 months, except for cases in which an infinite duration is indicated.

Incorrect. Pregnancy-associated spontaneous coronary artery dissection is the single most frequent cause of ACS during pregnancy and postpartum, mostly due to oestrogen and progesterone surges causing structural changes to coronary tunica media. Atherosclerotic lesions are the second most common cause.

Incorrect. Some ECG changes, such as transient ST-segment depression and T-wave inversion can be normal during pregnancy. However ST-segment elevation is not normal during pregnancy and warrants urgent attention. Serum troponin rise suggests myocardial injury as in non-pregnant women.

Correct. Wide differential diagnosis for chest pain in pregnant women should definitely be kept in mind, however it is always important to first exclude the most severe diagnoses, which typically present with the same symptoms in pregnant and non-pregnant women.

Incorrect. The duration of DAPT should be the same in pregnant women as in non-pregnant women, with an individual approach considering ischaemic risk and delivery-related bleeding risks. If single antiplatelet therapy is indicated, low-dose ASA is recommended. If DAPT is required, clopidogrel is recommended as the P2Y12 inhibitor of choice during pregnancy.

Incorrect. It’s true CMR is advised if other non-invasive diagnostic methods have failed to provide a clinical diagnosis. However evidence regarding gadolinium-based contrast in pregnancy is controversial and its use should be avoided unless absolutely necessary, even if excretion of gadolinium into milk is limited.

Incorrect. There is no evidence for this statement. If there is suspicion of new onset cardiovascular disease during pregnancy, submaximal exercise testing (80% of predicted maximal heart rate) can be very useful. Stress echocardiography using bicycle ergometry can even improve diagnostic specificity. However the use of pharmacological agents (dobutamine) should be avoided.

Correct. These diagnostic methods must generally be indicated when benefits outweigh the risks. ALARA means “as low as reasonably achievable”, preferably below 50mGy and should be clearly documented. Moreover, if possible, procedures should be delayed at least until the completion of major organogenesis (12 weeks of gestation).

Correct. Values of NT-proBNP and BNP throughout pregnancy and the early post-partum stages have a strong negative predictive value for heart failure. Repeated measurements can help us objectify potential new-onset or worsening symptoms.

Incorrect. These values are considered mild hypertension and pregnant women should already be started on pharmacologic therapy with the aim for BP lower than 140/90 mmHg.

Incorrect. Dihydropyridine calcium channel blockers can also be used alongside methyldopa and beta-blockers (labetalol, metoprolol). Diuretics are not advised due to the reduction of intravascular volume and reduction of uteroplacental perfusion and therefore possible fetal adverse effects. ACE-Is, ARBs and direct renin inhibitors are strictly contraindicated.

The decision was correct. BP values with systolic BP ≥160 mmHg and diastolic BP ≥ 110 mmHg are treated as an emergency and management in hospital settings is always recommended.

Correct. If the hypertension is well managed, delivery doesn’t have to be planned earlier.

Incorrect. Low-dose aspirin (75-150 mg daily) is recommended in this indication.

Correct. I.v. hydralazine is a second-line option.

Incorrect. For preeclampsia associated pulmonary oedema we typically administer an infusion of nitroglycerine, in combination with diuretics.

Incorrect. In women with pre-eclampsia without severe features, delivery is recommended at 37 weeks. In women with adverse markers such as haemostatic disorders, it is recommended to expedite delivery.

Incorrect. New-onset narrow QRS tachycardias in pregnancy are treated according to haemodynamic stability. In all cases of haemodynamic instability, electrical cardioversion is indicated.

Incorrect. First, we have to try vagal manoeuvres (Valsalva manoeuvre, carotid sinus massage), because they may terminate the arrhythmia. If these manoeuvres fail, i.v. adenosine is recommended.

Correct. These drugs are considered for pregnant women with preserved LVEF and rapid ventricular rate.

Incorrect. These drugs should be used in stable patients without structural heart disease. In patients with structural heart disease, electrical cardioversion is indicated.

Correct. If beta-blockers fail or aren’t tolerated, verapamil and digoxin should be considered as second-line rate control therapy.

Incorrect. Pregnant women with persistent or permanent atrial fibrillation should be on therapeutic LMWH anticoagulation regime.

Incorrect. Flecainide or propafenone are recommended for the prevention of arrhythmias in pregnant women with WPW syndrome. When AV-nodal blocking agents are used (like digoxin or verapamil), the risk of rapid ventricular rates is increased due to the drugs not blocking the accessory pathway.

Correct. At the same time we need to monitor pro-arithmic risk factors as in non-pregnant women and fetal growth. Flecainide can also be used in this indication, propafenone may be considered if flecainide isn’t available.

Correct. This is the safest therapeutic option due to risk of progression to hemodynamic collapse. Cardioversion terminates the arrhythmia safely and rapidly and restores organized ventricular activation.

Incorrect. Beta-blockers are used routinely, however the use of amiodarone is not recommended in pregnancy due to its potential fetal side effects such as bradycardia or IUGR. Amiodarone use should be limited to women with refractory or life-threatening arrhythmias that cannot be controlled with any other antiarrhythmic therapy.

Incorrect. The most common type of VT in pregnant women is idiopathic VT originating from the right ventricular outflow tract (RVOT). It is treated with beta-blockers or verapamil. On the other hand, VT due to structural heart disease is managed with beta-blockers and procainamide.

Correct. However if pharmacologic conversion or control fails, electrical cardioversion is indicated.

Incorrect. In pregnancy there are no changes in transthoracic impedance, so shock energies delivered should be the same as in non-pregnant women. Electrical cardioversion does not affect foetal circulation or induce foetal arrhythmia, though we still monitor foetal heart rate after cardioversion.

Correct. During implantation of an ICD, radiation exposure should be minimized and women should maintain their regular ICD care throughout pregnancy.

Incorrect. It’s true catheter ablation is used in cases of drug-refractory and poorly tolerated arrhythmias, when no other treatment options are available. However, we can significantly reduce the radiation risks when choosing to perform it in experienced centres with non-fluoroscopic electro-anatomical mapping and catheter navigation systems.

Incorrect. Most data indicate that maternal ICD shocks do not have major foetal adverse effects. The approach to pregnant women presenting with ICD shocks is no different from non-pregnant women - assessment of ICD and reprogramming or anti-arrhythmic drug therapy.

Incorrect. Chest compressions and defibrillation protocols are the same in pregnant women as in non-pregnant adults. However the preferred pad placement is antero-lateral, with the lateral pad being placed under the breast.

Correct. Pregnant women should be given any medication indicated during resuscitation because the immediate priority is maternal survival, which also maximizes fetal survival chances.

Incorrect. Immediate C-section should be considered just after 4 minutes of resuscitative efforts if ROSC hasn’t been established, while taking fetal viability, gestational age, comorbidities and available level of medical care into account.

Correct. The pregnant uterus can compress both the vena cava and aorta when the patient is supine. By relieving aortocaval compression, we can improve venous return to the heart and systemic perfusion pressure.

Correct. Managing a specific lesion pre-pregnancy can significantly lower the risk of heart failure during pregnancy.

Incorrect. For symptomatic mitral stenosis or mitral stenosis with pulmonary hypertension beta-blockers, diuretics and rest are suggested. Full therapeutic anticoagulation (LMWH or VKA) is indicated in those with atrial fibrillation, left atrial clot or previous embolism.

Incorrect. Medical therapy has a limited role in aortic stenosis. In very selected symptomatic pregnant women with severe aortic stenosis non-surgical options such as balloon valvuloplasty or TAVI may be considered.

Correct.This is the primary intervention pre- and during pregnancy for women who remain NYHA III/IV or with severe PAP elevation despite therapy.

Correct. Cardiac surgery is rarely required during pregnancy and vaginal delivery is preferred unless the mother is in refractory HF.

Correct. Diuretics are very effective in relieving the symptoms of congestion and highly indicated in this case.

Incorrect. The correct antiarrhythmics used are beta-bloker and/or flecainide. Close follow-ups and arrhythmic monitoring should follow.

Incorrect. Surgical treatment is recommended before pregnancy in women with severe aortic or mitral regurgitation with symptoms, impaired ventricular function or marked ventricular dilation.

Correct. Supine hypotensive syndrome is defined as systolic BP decrease of 15mm Hg due to the compression of the inferior vena cava by the uterus.

Incorrect. Mobitz type I AV block is common in pregnant women and rarely progresses during pregnancy. There are no data on progression of congenital conduction AV block during pregnancy.

Correct. Isoproterenol can be used if benefits outweigh the risks.

Incorrect. In the conditions described above, a prophylactic temporary pacemaker during delivery is not recommended.

Incorrect. Pulmonary hypertension represents one of the highest risks.

Correct. This will detect up to 80% of significant congenital cardiac defects.

Correct. Especially women using cardiac medication with teratogenic effect or beta-blockers, in which bradycardia and IUGR have been reported, need appropriate fetal monitoring. Foetal ductus venosus Doppler velocity can be a useful adjunct method of monitoring foetal well-being.

Correct. The measured values should also be compared against gestation-specific norms. Additional methods for diagnosing an arrhythmia include foetal echocardiography (at 20-22 weeks) and foetal magnetocardiography if available, to diagnose arrhythmia type and severity.

Incorrect. Mechanical valve implantation should be avoided when possible. Data from the ROPAC III study show that the chance of an uncomplicated pregnancy with a live birth in women with mechanical heart valves was 54%, compared to 79% in women with a tissue valve, significantly benefitting bioprosthetic valves. There is no compelling evidence that pregnancy is associated with accelerated valve deterioration.

Incorrect. The two most commonly used anticoagulation regimens are VKA (vitamin K antagonists) and LMWH. VKAs are used for higher risk of valve thrombosis and LMWH for lower risk. UFH may be used in rare circumstances such as the unavailability of anti-factor Xa monitoring.

Correct. According to the ROPAC III study, VKA therapy is associated with a higher risk of miscarriage. Although there is no safe dose for the fetus, event rates are reduced when lower doses of VKA are used. Because of this, VKAs are mostly used when the risk of thrombosis is high and the dose required to achieve target INR is low.

Incorrect. LMWH is not recommended when anti-factor Xa level monitoring is not available. In these circumstances, UFH (unfractionated heparin) may be used.

Correct. There are two peeks of possible HF deterioration during pregnancy - 23-30 weeks and peri-delivery. During pre-conception counselling, there should be a discussion about the risks and their management in terms of deterioration of cardiac function in pregnancy and peripartum. Early delivery will impact fetal outcomes.

Incorrect. Due to the high metabolic demands of lactation, avoiding it may be considered in women with severe HF.

Incorrect. SGLT2 inhibitors are also unsafe during pregnancy. Beta-blockers can be used with close maternal and foetal monitoring, but it is generally recommended non-selective beta-blockers are switched to beta-1-selective blockers (metoprolol, bisoprolol).

Correct. Therapeutic doses of LMWH are recommended in pregnant women with intracardiac thrombus or decreased LV function with EF below 35 %.

Correct. Levosimendan is used as a continuous infusion without an initial loading dose. Milrinone crosses the placenta, so risk versus benefit should be carefully considered.

Incorrect. While VA-ECMO is definitely highly preferred in pregnant women in refractory cardiogenic shock, urgent C-section with combined spinal/epidural analgesia or general anaesthesia is also recommended.

Incorrect. Loop diuretics and thiazides should be used with caution, but may be necessary in pulmonary congestion or echocardiographic signs of high LV end-diastolic pressure.

Correct. Ivabradine is contraindicated during pregnancy due to adverse effects on the fetus, but may be considered in the case mentioned above.

Correct. We also have to take individual risk factors into account. Women with heart transplantation are at a higher risk of experiencing cardiometabolic complications (pre-eclampsia, gestational diabetes mellitus, hypertension…) and should be counselled about maternal and foetal risks (rejection, infection, graft dysfunction, teratogenicity of drugs).

Incorrect. Mycophenolic acid is not recommended in pregnancy at all and should be discontinued 6 weeks before conception.

Correct. In cases where the father has the same HLA as the donated heart, there is a risk of developing donor-specific antibodies. Because of this, testing the father’s HLA before conception should be considered. Weekly monitoring of donor-specific antibodies should also be performed up to 6-12 months after delivery due to the risk of post-pregnancy rejection.

Correct. Levels should be monitored during pregnancy every 4 weeks until the 32nd week, then every 2 weeks until the 36th week, then weekly until delivery and for 6-12 months after delivery. This is because of the changes to maternal metabolism during pregnancy, which could affect the serum levels of immunosuppressive therapy.

Incorrect. It is recommended that pregnant women with cancer receiving cardiotoxic therapy are jointly managed by the Pregnancy Heart Team and the cardio-oncology team, not just an oncologist alone.

Correct. The current occurrence is 1 in 1000 pregnancies.

Correct. These should be measured prior to chemotherapy and during monthly or bimonthly follow-ups during chemotherapy to monitor cancer-therapy-related cardiac dysfunction.

Incorrect. The major risk factors include: cancer-therapy-related cardiac dysfunction, younger age at cancer diagnosis, higher cumulative dose of anthracycline and greater duration between cancer treatment and first pregnancy.

Incorrect. Post-partum hypertension can also develop de novo in women, who have never experienced issues with their blood pressure.

Incorrect. New-onset post-partum hypertension and especially post-partum preeclampsia is increasingly recognized as an important contributor to maternal morbidity and mortality in terms of cardiovascular health.

Correct. These signs include proteinuria, neurological symptoms and serum laboratory abnormalities. Post-partum preeclampsia and eclampsia pose a high risk for maternal morbidity and mortality and should be treated accordingly.

Correct. Especially women with pre-eclampsia have higher risk for several cardiovascular diseases including coronary artery disease, stroke, heart failure.

Correct. These drugs are used to treat hypertension in the first 6 weeks after giving birth.

Incorrect. It has been found that administering furosemide in the first 5 days post-partum in women with gestational hypertension and preeclampsia significantly reduces the prevalence of elevated blood pressure at 7 days after giving birth.

Incorrect. Metyldopa isn’t recommended post-partally due to the risk of post-partum depression.

Correct. The same medications are used for both scenarios.

Correct. Women with gestational diabetes mellitus have never experienced issues with glucose tolerance before their pregnancy.

Incorrect. Women with gestational diabetes mellitus have a higher risk of developing type 2 diabetes later in life and a significantly higher risk of adverse cardiac events. Even though the conditions tend to disappear after delivery, the risks remain.

Incorrect. Haemoglobin A1c is used to identify women at high risk of developing gestational diabetes mellitus. Postpartal women are recommended to undergo oral glucose tolerance test (oGTT) 6-12 weeks after giving birth.

Incorrect. After undergoing an oral glucose tolerance test (oGTT) at 6-12 weeks post-partum, another repeat assessment should be performed at 6-12 months. After that, annual glucose monitoring is recommended.

Incorrect. The earlier pre-term delivery occurs, the more strongly it is associated with hypertension and cardiovascular diseases later in life. These women are affected by both accelerated atherosclerosis and increasing blood pressure trajectory after birth.

Correct. Although the link to cardiovascular disease hasn’t been consistently proven yet, delivering a small for gestational age baby has been linked to hypertension and diabetes in women.

Incorrect. Pregnancy loss has been associated with an increased risk of cardiovascular disease later in life, specifically hypertension and type 2 diabetes, not gestational diabetes.

Correct. Women with pre-term deliveries are more likely to be affected by accelerated atherosclerosis independent of traditional risk factors for cardiovascular disease. They are also more likely to have an increasing blood pressure trajectory after pregnancy.

Incorrect. Breastfeeding even up to 12 months after birth has been shown to lower cardiovascular mortality, so there is no boundary set at 6 months.

Correct, longer breastfeeding periods are associated with better cardiovascular outcomes.

Incorrect. There is inconclusive evidence about the cardiovascular benefits of breastfeeding in older women (aged 55+ y.o.)

Correct. This is potentially the reason for breastfeeding having such a positive effect on cardiovascular health in postpartum women long-term.

Incorrect. It is generally not recommended to induce labour in women with stable cardiovascular disease earlier than 39 weeks. Any maternal benefit of early term delivery should be weighted against the increased likelihood of adverse foetal outcomes. If there are no maternal or fetal indications for an early birth, induction of labour before 39 weeks should be reserved for obstetrical indications.

Correct. Vaginal delivery is associated with less blood loss and lower risk of infection and venous thromboembolism and should be advised for most women. Planned C-section does not have any advantages against vaginal delivery in terms of maternal outcomes and it may even be associated with worse fetal outcomes.

Incorrect. Non-invasive BP monitoring is sufficient for a haemodynamically stable patient. Arterial lines should be reserved for those women who have haemodynamic instability or are at risk of it. Other methods are indicated and may help detect early signs of decompensation.

Correct. Endocarditis prophylaxis is also crucial during delivery.

Incorrect. Switching from VKA to heparin is recommended at least 2 weeks before planned delivery. High-risk women on therapeutic-dose LMWH should be converted to UFH 36h prior to delivery and UFH infusion should be stopped 4-6 hours before the anticipated delivery. Low-risk women should only stop their therapeutic LMWH dose 24h before delivery. This is why it is recommended to carefully plan the timing of delivery.

Incorrect. If a woman requires an urgent delivery and has been using VKAs within the last 2 weeks, the delivery via C-section is recommended to reduce the risk of foetal intracranial bleeding. We can try to prevent bleeding complications by administering four-factor prothrombin complex concentrate, vitamin K or fresh plasma as an alternative to prothrombin complex. In the case of heparin use, protamine sulfate should be given, however LMWH neutralization may be less effective.

Correct. Giving 2 IU oxytocin over 10min to a standard treatment of low-dose infusion for 4 h has been shown to significantly lower the volume of blood loss.

Incorrect. It is recommended to postpone the switch from heparin to VKA to 7-14 days post-partum to reduce the risk of late bleeding (bleeding after more than 24 hours post-partum is common), in consultation with the Pregnancy Heart Team.

Incorrect. In women with hypertensive disorders of pregnancy, blood pressure should be monitored in hospital for 72 hours after birth and checked again 7-10 days post-partum. We should try to optimize blood pressure levels from the immediate post-partum period as it can prevent the development of hypertension and improve long-term cardiovascular health.

Correct. This is due to the theory that prolactine plays a role in peripartum cardiomyopathy. The inhibition can be achieved with cabergoline or bromocriptine.

Correct. It should therefore be aggressively managed in the antenatal period.

Correct. Although the general risk for post-partum depression among new mothers in the general population is about 10-20%, the risk increases with underlying health conditions such as cardiovascular disease - 1 in 3 mothers with CVD has reported symptoms of depression post-partally. This means that early detection and psychological support should be a part of post-partum care.

Incorrect. Once- or twice-daily regimen, each resulting in a therapeutic dose is used in confirmed acute venous thromboembolism. However in mechanical heart valves, a twice-daily regimen with slightly higher doses is preferred.

Incorrect. VKAs will typically remain as anticoagulation therapy in women with atrial fibrillation in the context of moderate to severe mitral valve stenosis or mechanical heart valves, given the lower thrombosis risk with VKAs compared to LMWH.

Correct. Although not crossing the placenta, UFH is associated with higher risks of thrombocytopenia and osteoporosis compared with LMWH.

Incorrect. DOACs are not recommended in pregnancy and they should only be used in the absence of any other option in consultation with the Pregnancy Heart Team and the haematology team.

Incorrect. Ticagrelor is contraindicated due to embryotoxicity. Clopidogrel is considered safe if dual antiplatelet therapy is needed for the shortest possible duration. There is no teratogenic effect reported for aspirin doses up to 300mg daily.

Correct. SGLT2 inhibitors cross the placenta and exposure to them may cause fetal damage in rodents, especially during the second and third trimesters. Diuretics may be used in pregnancy to treat systemic hypertension or HF-related overload conditions. Care must be taken to monitor reduction in plasma volume and decrease in placental perfusion.

Correct. Amiodarone causes fetal abnormalities, bradycardia and thyroid dysfunction and its routine use is contraindicated. However single-dose may be used in emergencies such as ventricular tachycardia storms.

Correct. These medications may cause fetal malformations, IUGR and even death. Captopril, enalapril, and benazepril are safe during lactation, whereas ARBs are not recommended. Spirinolactone is also considered safe during lactation.

Incorrect. Statins now remain contraindicated only during lactation, as the evidence that statins increase the risk of miscarriage was insufficient.

Correct. Labetalol and lipophilic drugs (metoprolol, propranolol, carvedilol) are preferred in pregnancy as well as beta-1-selective drugs.

Incorrect. No information is available on its safety in patients with CVD. Zuranolone is excreted in the mild and lactation should be avoided in the absence of safety data.

Correct. On the other hand, mycophenolate derivatives should be discontinued before conception.