Pregnancy with heart disease
Introduction
Introduction to pregnancy combined with heart disease Pregnancy with heart disease is a serious complication of obstetrics and is the third leading cause of maternal death in China, accounting for the first cause of non-direct obstetric death. As the uterus is enlarged, the blood volume is increased, and the burden on the heart is aggravated. When the uterus and the skeletal muscle contraction during childbirth cause a large amount of blood to flow to the heart, and the blood volume of the postpartum is increased, it is easy to cause heart failure in the diseased heart. At the same time, due to chronic chronic hypoxia, fetal intrauterine dysplasia and fetal distress. Clinically, pregnancy is associated with rheumatic heart disease, and there are congenital, pregnancy-induced hypertension, perinatal cardiomyopathy, and anemia. Pregnancy with heart disease is one of the main causes of maternal death. basic knowledge The proportion of the disease: the incidence rate of pregnant women is about 0.01% - 0.02% Susceptible population: pregnant women Mode of infection: non-infectious Complications: heart failure subacute infective endocarditis
Cause
Pregnancy with heart disease
Infection factor (75%)
Pulmonary infection can cause heart failure due to increased resistance to pulmonary circulation; anemia and hypoproteinemia can aggravate myocardial hypoxia; due to systemic small arterial spasm during pregnancy-induced hypertension, increased peripheral resistance increases left ventricular end-diastolic pressure, heart The post-load increases, and the heart preload is increased due to the retention of water and sodium and the increase in blood volume, which is prone to heart failure.
Iatrogenic factors (15%)
The iatrogenic heart failure caused by excessive postpartum fluid replacement can not be ignored. Therefore, actively seeking incentives, early diagnosis and timely treatment is extremely important for the prevention and treatment of heart failure.
Pathogenesis:
The hemodynamics during pregnancy changed significantly, and the cardiac output increased by 30% to 40% in a quiet state. At 32-34 weeks of gestation, blood volume increases to the highest peak, resulting in insufficient myocardial blood supply and increased ventricular load. At the same time, changes in hemodynamics cause neuroendocrine changes, sympathetic excitability increases, leading to contraction of small pulmonary arteries and surrounding small blood vessels. Hemorrhoids, especially with anemia, infection and hypertensive disorders of pregnancy, will further increase the left and right ventricular resistance load, reduce cardiac output, induce or aggravate heart failure, and even myocardial degeneration or cardiac arrest.
Prevention
Pregnancy with heart disease prevention
Clinically, by evaluating the status of heart function in women of childbearing age or pregnant women, it is possible to determine whether pregnancy or pregnancy can be continued. Maternal heart function status has a great influence on the mode of delivery and pregnancy outcome, and is closely related. Therefore, it is necessary to closely monitor the heart function during pregnancy, and choose the appropriate mode of delivery and timing to terminate the pregnancy in time to help prevent heart failure. With the increase in the number of prenatal examinations, the incidence of adverse pregnancy outcomes such as postpartum hemorrhage, infection, neonatal asphyxia, and neonatal death decreased significantly.
Strengthen perinatal monitoring and prenatal examination, to achieve early prevention, early diagnosis, early treatment, early care, active treatment of primary disease, maximize heart function, reduce heart failure induced factors, is to reduce heart disease and heart disease during pregnancy The incidence of failure and the key to maternal adverse pregnancy outcomes. Specific measures include
1. Reduce the burden on the heart and improve the function of cardiac compensatory; limit physical activity, increase rest time, ensure adequate sleep, and maintain emotional stability.
2, the left lateral position, in order to maintain the stability of the blood flow back, increase the amount of heart beat.
3, reasonable nutrition and proper weight control, high protein, less fat, more vitamins, low-salt diet, prevention and treatment of sodium and water, so as not to increase the burden on the heart. The weight gain during the whole pregnancy should not exceed 10KG. After 16 weeks of gestation, the daily salt intake does not exceed 4 to 5 g.
4, active prevention and treatment can lead to increased heart load, induced heart failure, such as anemia, hypoproteinemia, upper respiratory tract infection, pregnancy-induced hypertension syndrome, hyperthyroidism, tachycardia.
5, severe heart disease in the third trimester of pregnancy can be appropriate to prevent diuretics.
Complication
Pregnancy with heart disease complications Complications heart failure subacute infective endocarditis
Can be complicated by heart failure, subacute infective endocarditis, venous embolism and other diseases.
Symptom
Pregnancy with heart disease symptoms Common symptoms Chest tightness pregnant women chest tightness shortness of breath chest tightness hernia stretch marks
Early symptoms of heart failure, such as chest tightness, shortness of breath, palpitation, and nighttime awakening should be treated in time to avoid heart failure.
Early heart failure performance:
1. Chest tightness, shortness of breath and palpitations after a slight activity.
2, sleep in the suffocating, chest tightness and wake up, even sit up or walk to the window to breathe fresh air.
3, heart rate when the body rate exceeds ll0 / min.
4, breathing more than 20/min at rest
Multiple groups: original heart disease, such as rheumatic heart disease and congenital heart disease and pregnancy-induced heart disease, such as hypertensive disease heart disease, perinatal cardiomyopathy and other women of childbearing age and pregnant women are heart failure High-risk groups.
Examine
Pregnancy with heart disease check
Pregnant women's signs:
1 diagnosis of heart disease in pregnancy should be asked in detail about the history of heart disease, especially rheumatic heart disease and rheumatic fever history; cardiac signs have diastolic murmur, grade III or above systolic murmur, severe arrhythmia, suggesting that heart disease. X-ray examination and ECG and echocardiographic changes.
2 grade III or above systolic murmur, rough nature and longer time limit should consider the diagnosis of heart disease. Sometimes the diagnosis is difficult and needs to be confirmed after the postpartum follow-up.
3 severe arrhythmia, such as atrial flutter, atrial fibrillation, atrioventricular block, diastolic gallop, all suggestive of myocardial lesions; and premature beats and paroxysmal supraventricular tachycardia can sometimes be In pregnant women without heart disease, it should be noted that identification should be noted.
Maternal history:
Pregnant women should be asked in detail when they have a history of heart disease, especially rheumatic heart disease and rheumatism. In the past, the diagnosis and treatment, whether there is heart failure and so on.
Auxiliary diagnosis
1 routine ECG examination can help diagnose.
2 Echocardiography can help to diagnose the presence or absence of pulmonary hypertension and congenital heart disease.
Diagnosis
Diagnosis of pregnancy complicated with heart disease
diagnosis
At present, the clinical diagnosis of early heart failure is still based on the patient's symptoms, chest X-ray, electrocardiogram, echocardiography and other comprehensive judgments. The main criteria: 1, paroxysmal dyspnea or sitting breathing at night. 2, jugular vein engorgement. 3, the lungs smell and wet voice. 4. The heart expands. 5. Acute pulmonary edema. 6, diastolic galloping. 7, venous pressure increased>1.57kPa: 8, cycle time> 25 seconds. 9, liver and neck reflux sign positive. Secondary criteria: 1, foot edema; 2, night cough; 3, difficulty breathing when tired; 4, liver enlargement; 5, pleural effusion; 6, lung capacity reduced to the maximum l / 3; 7, tachycardia Speed (heart rate > 120/min). Heart failure can be determined by having two major criteria or one primary criterion and two secondary criteria in the above criteria.
Cardiac function classification is divided into systolic dysfunction and diastolic dysfunction type heart failure, chronic heart failure, also known as congestive heart failure. Grading criteria: Grade I: general physical activity is not restricted; Grade II: general physical activity is slightly restricted, daily work fatigue is uncomfortable; Grade III: general physical activity is significantly restricted, minor activities are uncomfortable or incompetent, and improved after rest . Have had a history of heart failure; Grade IV: Not qualified for any physical activity, still have palpitations, shortness of breath, etc. during rest.
Differential diagnosis: Since normal pregnancy itself can have a series of symptoms similar to heart disease, such as palpitations, shortness of breath, edema of the foot and ankle, etc., many patients mistakenly believe that the performance of heart disease is a normal phenomenon after pregnancy, and even appeared Symptoms of early heart failure such as paroxysmal dyspnea and persistent cough should be differentiated from upper respiratory tract infections.
