Heart disease during pregnancy

Introduction

Introduction to heart disease during pregnancy

Pregnancy with heart disease is a serious complication of obstetrics and is the leading cause of maternal mortality. The incidence rate is 0.5-1.5%. Due to pregnancy, uterus enlargement, increased blood volume, increased heart burden, uterine and systemic skeletal muscle contraction during childbirth causes a large amount of blood to flow to the heart, and the increase in circulating blood volume after birth is easy to cause heart failure in the diseased heart. Pregnancy with heart disease, pregnancy-induced hypertension syndrome, and postpartum hemorrhage are the three major causes of maternal death. Pregnancy with heart disease, rheumatoid heart disease is the most common, accounting for about 80%, especially mitral stenosis is the most common, is a serious pregnancy complications, maternal deaths in China accounted for the second place. 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. Whether a heart patient can safely pass through pregnancy or childbirth depends on the heart function, so the disease must be highly valued.

basic knowledge

Sickness ratio: 0.0001%

Susceptible population: pregnant women

Mode of infection: non-infectious

Complications: heart failure subacute infective endocarditis heart failure pulmonary embolism

Pathogen

Cause of heart disease during pregnancy

The original heart disease (25%):

The original heart disease is mostly rheumatic and congenital heart disease. Hypertensive heart disease, mitral valve prolapse and hypertrophic heart disease are rare.

Pregnancy factors (35%):

Pregnancy-induced heart disease, such as pregnancy-induced hypertension, heart disease, and perinatal heart disease. (1) Increased blood volume during pregnancy. (2) The output of the heart increases, reaching a peak in the 13th to 23rd week of pregnancy. (3) During the pregnancy, the diaphragm is rising, the large blood vessels are twisted, and the heart and blood vessel position are changed, which increases the burden on the heart. (4) Increased metabolism during pregnancy.

Prevention

Pregnancy heart disease prevention

1) Antibiotics should be given at the beginning of the labor process to actively prevent infection. Body temperature 4 times a day, pulse and breathing.

2), to make the maternal quiet rest, can give a small amount of sedatives, intermittent oxygen, prevent heart failure and fetal distress.

3) If there is no indication for cesarean section, it can be delivered through the vagina, but the labor process should be shortened as much as possible. Feasible perineal lateral incision, forceps and so on. Closely observe the heart function. Due to the prolonged labor process, the burden on the heart can be increased, so the indication for cesarean section can be appropriately relaxed. Epidural anesthesia is preferred. In the event of heart failure, it is necessary to actively control heart failure and then undergo cesarean section.

4) After the baby is delivered, put a sandbag under the abdomen to prevent the abdominal pressure from suddenly reducing heart failure, and immediately inject morphine 0.01 g or 0.2 g of phenobarbital sodium. If the postpartum hemorrhage exceeds 300 ml, the intramuscular injection of oxytocin is 10 to 20 units. When transfusion is required, care should be taken not to be too fast.

5) Maternal maternity should be fully rested during the calving period. Closely observe body temperature, pulse, heart rate, blood pressure and vaginal bleeding. Be alert to heart failure and infection. Followed by antibiotics. Sterilization should be considered.

Complication

Pregnancy heart disease complications Complications heart failure subacute infective endocarditis heart failure pulmonary embolism

1. Heart failure, the most likely to occur in the 32-34 weeks of pregnancy, childbirth and early calving. Master the characteristics of early heart failure:

1 After a slight activity, chest tightness, palpitations, and shortness of breath appear.

2 The heart rate is more than 110 beats per minute at rest and more than 20 beats per minute.

3 often sit up for breathing due to chest tightness at night, or breathe fresh air at the window.

4 A small amount of persistent wet sputum appears at the bottom of the lungs and does not disappear after coughing.

2. Subacute infective endocarditis can induce heart failure if not controlled in time.

3. Venous embolism and pulmonary embolism, the blood is hypercoagulable during pregnancy. Heart disease with increased venous pressure and venous stasis, sometimes deep vein thrombosis, embolism can induce pulmonary embolism, is an important cause of death for pregnant women.

Symptom

Symptoms of heart disease during pregnancy Common symptoms Heart palpitations, systolic murmur, wheezing, heart failure, arrhythmia, bacteremia, pulmonary embolism, conduction block, patent ductus arteriosus

1. Heart failure: If the heart function of the heart disease has been damaged or reluctantly compensated, further heart function compensation may be due to pregnancy. In pregnant women with rheumatic heart disease, cardiac dysfunction is as follows:

1 lung abandonment of blood: more common in mitral valve disease, the patient is more urgent, tired after fatigue, the lungs at the base of the lungs have fine wet rales. X-ray examination showed interstitial edema.

2 acute pulmonary edema: more common in severe mitral stenosis, due to high blood volume caused by increased pulmonary hypertension. The patient suddenly became anxious, unable to lie flat, coughing, foamy or bloody, and the lungs were scattered in wheezing or wet rales.

3 right heart failure: common in older age, more significant heart enlargement, atrial fibrillation, usually have labor loss, or have a history of mental exhaustion. In pregnant women with congenital heart disease, patent ductus arteriosus, atrial septal defect, ventricular septal defect and other pulmonary hypertension, often lead to right heart failure; pulmonary stenosis and tetralogy of Fallot, due to excessive pressure on the right ventricle, too much Expressed as right heart failure.

4 aortic stenosis can be left heart failure due to excessive left ventricular pressure overload.

2. Infective endocarditis: Infectious endocarditis can be caused by bacteremia, whether it is rheumatic heart disease or congenital heart disease. If not controlled in time, it can cause heart failure and kill.

3. Hypoxia and cyanosis: In the cyanotic congenital heart disease, there is usually hypoxia and cyanosis, and the peripheral resistance during pregnancy is low, and the cyanosis is aggravated. Non-cyan-type, left-to-right shunt pregnant women with congenital heart disease, if blood pressure drops due to blood loss and other reasons, can cause temporary reverse shunt, that is, right to left shunt, causing cyanosis and hypoxia.

4. Embolization: During pregnancy, the blood is in a hypercoagulable state, coupled with increased venous pressure associated with heart disease and venous stasis, which is prone to embolism. Thrombosis may come from the pelvic cavity, causing pulmonary embolism, increasing pulmonary circulation pressure, thereby stimulating pulmonary edema, or reversing the left-to-right shunt to a right-to-left shunt. If it is a congenital heart disease in the left and right heart chambers, the thrombus may cause peripheral arterial embolization through the defect.

5. Pregnancy with heart disease patients from the beginning of pregnancy to several weeks after delivery, the mother can undergo a series of complex changes. The cardiac output increased from the 10th to 12th week of pregnancy, and reached the highest peak in the supine position on the 20th and 24th week of pregnancy. It increased by 30-40% compared with the rest of the pregnant women, and returned to normal two weeks after birth. The heart rate during pregnancy is faster than that of non-pregnant women. It can increase by about ten times per minute in near-term and more in twins. Blood volume begins to increase from the 6th to 10th week of pregnancy and peaks at the 32nd to 34th week, which is 30-50% higher than when it is not. The blood volume generally includes the amount of plasma and the amount of red blood cells. Although the amount of red blood cells increases during pregnancy, it increases by more than 18% in full term, but the amount of plasma increases by about 50%, which is more than the increase of red blood cells. Therefore, the number of red blood cells and hemoglobin The concentration is relatively reduced due to dilution, forming a "physiological anemia." Due to fetal growth and development, as well as maternal circulation and increased respiratory work, oxygen consumption is increasing, reaching a peak at delivery (up 20% over non-pregnancy). During pregnancy, the body water content gradually increases, the plasma osmotic pressure decreases; the uterus gradually increases, compressing the inferior vena cava, causing the inferior vena cava pressure to rise; plus gravity, most pregnant women have edema in the calves and ankles. In the third trimester of pregnancy, the uterus is significantly enlarged, causing the diaphragm to rise, the heart is in a horizontal position, the blood vessels are flexed, and the right ventricle is elevated. These changes all increase the burden on the heart.

Examine

Examination of heart disease during pregnancy

1 routine ECG examination can help diagnose. Cardiac function monitoring includes clinical observation, auxiliary examination such as ambulatory blood pressure monitoring, electrocardiogram, and related blood biochemical indicators.

2 Echocardiography A set of non-invasive methods of examination, even if ultrasound echo is used to probe the heart and large blood vessels for information. Including M-mode ultrasound, two-dimensional ultrasound, pulsed Doppler, continuous Doppler, color Doppler flow imaging can help to diagnose the presence or absence of pulmonary hypertension and congenital heart disease.

Diagnosis

Diagnosis of heart disease during pregnancy

diagnosis

If you have a structural heart disease before pregnancy, of course, there is no diagnosis, but some patients may have no symptoms and do not seek medical treatment. A series of changes in the cardiovascular system caused by pregnancy can lead to palpitations, shortness of breath, edema, etc. Symptoms may also be accompanied by mild enlargement of the heart, signs of heart murmurs, and changes in X-rays and electrocardiograms, which may increase the difficulty in diagnosis of the heart. However, if the following abnormalities are found, organic heart disease should be considered.

1, grade III or above, rough systolic murmur.

2, diastolic murmur.

3, severe arrhythmia, such as atrial fibrillation or flutter, atrioventricular block.

4, X-ray film shows that the heart shadow is obviously enlarged, especially the individual atrium or ventricle is obviously enlarged.

5. Echocardiography shows heart valve, atrial and ventricular lesions.

The main identification of this disease is pregnancy with heart disease or heart disease with pregnancy.