perinatal cardiomyopathy
Introduction
Introduction Found in perinatal cardiomyopathy, a type of heart disease that occurs before and after a woman's delivery, the cause of which is unknown, with myocardial lesions as the basic feature and congestive heart failure as the main manifestation. The domestic incidence rate of this disease is about 0.023% of the mother. The incidence of advanced, prolific, multiple births and maternal history of pregnancy poisoning is higher. The prognosis of this disease is better than that of primary cardiomyopathy.
Cause
Cause
The cause of perinatal cardiomyopathy is still unclear. Most experts in the medical community believe that it may be related to factors such as malnutrition, fear, high blood pressure, infection and family history. This disease occurs mostly in elderly or twin-born pregnant women, and is generally more common in rural women of childbearing age.
The etiology of peripartum cardiomyopathy may be related to viral infection, autoimmune factors, selenium deficiency, and nutritional deficiencies. Clinically, it should be carefully excluded whether there is misdiagnosis caused by symptoms of underlying heart disease during pregnancy, age factors (greater than 30 years old), prolificacy, malnutrition, multiple births, pregnancy-induced hypertension syndrome, postpartum hypertension, and Areas (such as low selenium areas) can be attributed to risk factors or predisposing factors.
Examine
an examination
Related inspection
Doppler echocardiography dynamic electrocardiogram (Holter monitoring)
[symptoms]
1. The heart expands. The left ventricle is mainly enlarged.
2. Heart failure. It is characterized by progressive exacerbation of labor dyspnea and signs of systemic congestion.
3. Arrhythmia: all types of arrhythmia have, most common in early morning and atrial fibrillation.
4. Embolization: Embolization of the brain, lung and renal arteries is the most common.
[Diagnose based on]
1. Pregnancy women have symptoms of heart enlargement and heart failure from 3 months before delivery to 6 months after delivery; 2. The clinical features are consistent with the changes of dilated cardiomyopathy.
Diagnosis
Differential diagnosis
Because the cause of the disease is unclear, the pathological changes are not specific, and its clinical manifestations are not characteristic, so differential diagnosis is particularly important. Differential diagnosis should be excluded to exclude various causes of cardiac dysfunction, including various heart diseases before pregnancy, such as valvular heart disease, myocarditis, congenital heart disease and other primary or secondary cardiomyopathy or hypertension. Sexual heart disease, etc. Care should be taken not to diagnose heart failure caused by pregnancy-induced hypertension as PPCM, but also to identify signs of heart failure caused by diseases such as severe anemia, vitamin B1 deficiency, amniotic fluid embolism or pulmonary embolism. In addition, it is not possible to reduce the shortness of breath, exercise endurance, lower extremity edema, and physiological heart in some pregnant women during the second trimester of pregnancy. The uterus is enlarged to cause the heart to shift due to the lifting of the sputum, and to smell the physiological third heart sound and The systolic murmur in the apical region is misdiagnosed as PPCM.
Pregnancy-induced hypertension complicated with heart failure
PPCM can be associated with hypertension, proteinuria and edema, often confused with heart failure caused by pregnancy-induced hypertension, especially attention should be paid to identification. The heart failure induced by pregnancy-induced hypertension caused by heart damage can be seen clinically. The clinical manifestations are mainly hypertension, proteinuria and edema. When blood pressure is significantly increased, coronary artery spasm leads to myocardial ischemia and even focal necrosis. Induced cardiac dysfunction, but the heart did not significantly expand, there is no serious arrhythmia, often accompanied by kidney damage. PPCM is an unexplained left heart failure, the heart is significantly enlarged, and there may be severe arrhythmia. Although it can be combined with pregnancy-induced hypertension, blood pressure, proteinuria, and edema are not prominent, and kidney damage is extremely rare.
Hypertensive heart disease
The patient has a history of chronic hypertension before pregnancy, and his heart enlargement and changes in cardiac function have to undergo a certain course of disease.
Coronary heart disease
Patients with coronary heart disease are generally older, often have angina pectoris, a history of myocardial infarction, normal or slightly larger heart, and ECG is a localized ischemic ST-segment depression or abnormal Q-wave.
Anemia heart disease
The peripheral blood of the patient measures hemoglobin for a long time below 50-60g/L. If the anemia is corrected, the symptoms can disappear and the heart function can return to normal.
Beribillary heart disease The heart changes to myocardial rupture, degeneration and edema, heart enlargement, heart failure, similar to the pathological manifestations of PPCM, but patients have a long history of vitamin B1 deficiency and signs of peripheral neuritis. Vitamin B 1 supplementation is excellent.
[symptoms]
1. The heart expands. The left ventricle is mainly enlarged.
2. Heart failure. It is characterized by progressive exacerbation of labor dyspnea and signs of systemic congestion.
3. Arrhythmia: all types of arrhythmia have, most common in early morning and atrial fibrillation. 4. Embolization: Embolization of the brain, lung and renal arteries is the most common.
[Diagnose based on]
1. Pregnancy women have symptoms of heart enlargement and heart failure from 3 months before delivery to 6 months after delivery; 2. The clinical features are consistent with the changes of dilated cardiomyopathy.
