Pulmonary blood abandonment

Introduction Cardiac dysfunction during pregnancy is characterized by: lung abandonment, acute pulmonary edema, right heart failure, etc. Heart disease during pregnancy can be divided into two broad categories. The first category is the original heart disease, which is mostly rheumatic and congenital heart disease. Hypertensive heart disease, mitral valve prolapse and hypertrophic heart disease are rare. The second category is pregnancy-induced heart disease, such as pregnancy-induced hypertension heart disease, perinatal heart disease.

Cause

The disease often has the following two causes:

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

2. Pregnancy-induced heart disease, such as pregnancy-induced hypertension, heart disease, and perinatal heart disease.

an examination

Related inspection

Electrocardiogram pulmonary ventilation imaging

Clinical manifestation

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 patients 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, also manifested as right heart failure. Aortic stenosis can be manifested as left heart failure due to excessive left ventricular pressure overload.

2, infective endocarditis: regardless of rheumatic heart disease or congenital heart disease can be complicated by bacteremia and infective endocarditis. If not controlled in time, it can cause heart failure and death.

3, hypoxia and cyanosis: in the cyanotic congenital heart disease, usually there is hypoxia and cyanosis, peripheral resistance during pregnancy is low, 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, embolism: during pregnancy, the blood is in a hypercoagulable state, coupled with heart disease associated with increased venous pressure and venous stasis, easy to concurrent 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.

diagnosis

If you have an organic heart disease before pregnancy, there is certainly no diagnosis, but some patients may have no symptoms and do not seek medical attention. A series of changes in the cardiovascular system caused by pregnancy can lead to symptoms such as palpitations, shortness of breath, edema, and may be accompanied by signs of mild heart enlargement, heart murmur, and X-ray and ECG changes, thereby increasing the difficulty of cardiac diagnosis. However, if you find the following abnormalities, you should consider the presence of organic heart disease.

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.

Differential diagnosis

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

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