Chest pain during pregnancy

Introduction Chest pain during pregnancy refers to chest pain that occurs during pregnancy. Most of the chest pains that occur during pregnancy are clinically manifested by pain in the precordial area or angina pectoris. It is caused by pregnancy-induced myocardial infarction. Pregnancy myocardial infarction is a rare pregnancy complication. There are very few domestic reports. This type of myocardial infarction is different from other types of myocardial infarction because it not only endangers the life of the pregnant woman, but also poses a threat to the fetus. The clinical manifestations of pregnancy myocardial infarction have important reference and diagnostic value for diagnosis.

Cause

Family genetic factors

A positive family history of myocardial infarction before the age of 60, such as a positive family history of hyperlipidemia, hypertension, and diabetes.

2. Disease factors

Various conditions of abnormal lipid metabolism, such as persistent or refractory hypertension, diabetes.

3. Bad factors

Smoking, alcohol, and drugs.

4. Environmental factors

Women with type A personality and those with emotional instability and life stress.

5. Disease factors related to pregnancy

Pregnancy and pregnancy, pregnancy with diabetes; pregnancy thromboembolic complications (occurring in thrombophlebitis, myocarditis, chronic atrial fibrillation, atrioventricular block, bacterial endocarditis, primary cardiomyopathy, etc.).

6. Factors related to female endocrine

Insufficient female hormone secretion, amenorrhea or artificial menopause, long-term oral contraceptives.

7. Other factors

Congenital anomalies, such as abnormal coronary origin and aortic stenosis, coronary arteritis, hypertrophic cardiomyopathy, vasospasm, etc.

According to foreign reports, coronary angiography in patients with pregnancy complicated with myocardial infarction is often normal. It is speculated that coronary blood flow may be reduced due to sputum or local thrombosis. The cause of delirium is unclear, considering that it may be associated with pregnancy with hypertension, or with drugs such as oxytocin. Separation of coronary dissection during pregnancy or postpartum is also a common cause.

an examination

Related inspection

Dynamic electrocardiogram (Holter monitoring) ECG blood routine

The clinical manifestations of pregnancy myocardial infarction have important reference and diagnostic value for diagnosis. Pregnancy myocardial infarction has the following major clinical manifestations.

Chest pain during pregnancy

Most of the chest pains that occur during pregnancy are caused by pain in the anterior region or angina pectoris. It is often clinically easy to treat this pain with the esophagus and/or digestive tract (gastric acid irritation, pyloric spasm, ulcer disease). "burning heart" is confused. Therefore, clinically, chest pain or angina pectoris should be screened during pregnancy, especially in patients with acute sweating, generalized tightness, or persistent exacerbation of chest pain after general treatment, should be highly suspected of pregnancy myocardial infarction.

2. Symptoms and signs that may be similar to normal pregnancy physiology

Pregnancy myocardial infarction due to the relationship between the number and location of myocardial infarction, many symptoms and signs that may be similar to normal pregnancy can be found in clinically observed symptoms and physical examinations, and need to be identified.

(1) Symptoms: Activity tolerance is reduced and breathing is difficult.

(2) signs: peripheral edema, jugular vein engorgement, apex beat ectopic.

(3) Cardiac auscultation: the first and second heart sounds of the split, the third heart sound (S3) gallop, the jet murmur on the left sternal border, the continuous murmur (from the breast vein murmur), non-pathological diastolic The murmur has reached 10%. According to the above symptoms and signs, the dynamic evolution of electrocardiogram and myocardial enzyme should be observed regularly to help early diagnosis and timely treatment.

Differential diagnosis

1. Identification of chest pain or angina during pregnancy:

When there is persistent and gradually worsening chest pain during pregnancy, it is accompanied by sweating, chest "tightening" and "burning heart" feeling. When treatment can not be relieved, the possibility of myocardial infarction should be highly suspected. Chest pain during pregnancy, should promptly rule out gastrointestinal diseases, such as hyperacidity, "heartburn" caused by pyloric sputum, and sputum caused by increased abdominal pressure in the third trimester. Of course, it is also necessary to distinguish between episodes of chest pain caused by "X syndrome", "variant angina", and "cardiovascular spasm syndrome".

2. Identification of certain clinical signs and symptoms during pregnancy:

When pregnant women have jugular vein engorgement, sweating, pale, cold limbs, or other symptoms, such as bradycardia, hypotension, arrhythmia, especially patients with chest pain, should think of this disease may. At this point, it needs to be differentiated from heart failure and other complications caused by some heart disease.

3. Electrocardiogram identification of pregnant myocardial infarction:

It is the most convenient and convenient method for diagnosing myocardial infarction in pregnancy. However, when reading and evaluating the electrocardiogram, attention should be paid to the physiological Q wave and normal T during normal pregnancy due to the increase of the transverse sputum and the change of the heart position. QIII and T wave inversion may occur, which is more common in the late pregnancy. QIII accounts for about 5% of normal pregnant women, and TV4 inversion accounts for about 8%. These are not caused by myocardial lesions. Domestic Zhang Guofen reported that deep QIII, inverted TV3 and left axial shift of electrical axis may occur during pregnancy. In addition, predisposition to functional arrhythmia during pregnancy, mainly pre-systolic and supraventricular paroxysmal tachycardia, should be identified in the diagnosis. ECG changes in pregnant myocardial infarction are a series of QRS-ST-T evolution processes, so clinically, ECG changes should be screened for normal pregnancy.

4. Diagnosis and identification of serum enzymatic changes in pregnant myocardial infarction should pay attention to the following points:

(1) Increased G0T activity during pregnancy and puerperal period contributes to the diagnosis of myocardial infarction: but this enzyme activity is also increased during pregnancy poisoning, indicating that the differential diagnosis of pre-eclampsia and hypertension or early kidney disease is helpful. The latter two have no combined pregnancy.

(2) Increased CK-MB activity has sensitive diagnostic value: However, during childbirth, CK-MB activity level is also different due to different delivery methods. CK-MB activity is higher than vaginal delivery. some.

(3) Detection of other enzymes also contribute to the diagnosis of myocardial infarction.

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