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Left → right shunt ① atrial septal defect ② ventricular septal defect ③ patent ductus arteriosus
Congenital heart disease
No shunt ① pulmonary artery stenosis ② coarctation of the aorta ③ Marfan syndrome
ventricular end-diastolic volume wall muscle mass contractility
Heart rate increase
10 to 15 beats per minute
6
Physiological Changes 3
Labour leads to further increases in cardiac output In the first stage: 15% In the second stage: 50%
32 to 34 weeks Intrapartum 3 days postpartum
Easily induced heart failure
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Types of CD during pregnancy
Congenital heart disease Rheumatic heart disease Hypertensive disorders in pregnancy heart disease Peripartum cardiomyopathy Other
• right → Left shunt: • Tetralogy of Fallot 、
Eisenmenger's syndrome
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Rheumatic heart disease
Aortic stenosis: severe Pulmonary edema Low discharge capacity heart failure Aortic incompetence : severe Left ventricular failure Bacterial endocarditis
Blood viscosity increased to promote myocardial ischemia
Cardiac Disease in Pregnancy
Women's Hospital School of Medicine Zhejiang University
1
Physiological Changes in the Cardiovascular System During Pregnancy
A thorough knowledge
essential
In order to understand
the additional impact of cardiac disease
2
精品资料
• 你怎么称呼老师？
• 如果老师最后没有总结一节课的重点的难点，你 是否会认为老师的教学方法需要改进？
7
Physiological Changes 4
After delivery, cardiac output increases again immediately : 60-80%
sudden interruption of placental circulation uterine contraction relief of caval compression within 1 h: rapid decline to pre-labour values
• 你所经历的课堂，是讲座式还是讨论式？ • 教师的教鞭
• “不怕太阳晒，也不怕那风雨狂，只怕先生骂我 笨，没有学问无颜见爹娘 ……”
• “太阳当空照，花儿对我笑，小鸟说早早早……”
Physiological Changes 1
The first cardiovascular change associated with pregnancy
Puerperium:
uterine contractions retented Interstitial fluid returned to circulation return to normal after 2 weeks
8
Physiological Changes 5
The greatest change period in systemic blood circulation and heart burden
Peripheral vasodilation (induced by progesterone)
leading to
A decrease in systemic vascular resistance
5
Physiological Changes 2
Cardiac output increases 8 weeks : 20% 20-28 weeks :40-50% Stroke volume increase 80ml/t
abdominal pressure plummeted pain and anxiety : sympathetic stimulation pulmonary artery pressure increased blood back into the circulation with each uterine contraction: 300-500 se
No history of heart disease and signs Sudden onset of systemic failure
left ventricular failure
Peripheral small artery resistance increased Myocardial ischemia, interstitial edema, hemorrhage and necrosis spots