产科学英文ppt课件:5-heart-disease-pregnancy.pptx
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1、HEART DISEASE IN PREGNANCYIntroductionIntroductionTheincidenceofcardiaclesionislessthan1%amonghospitaldeliveries.Thecommonestcardiaclesionisofrheumaticoriginfollowedthecongenitalones.InwesterncountriesmaternalheartdiseaseisnowthemajorcauseofmaternaldeathduringpregnancyUK2003-2005.Physiological chang
2、es in Physiological changes in pregnancypregnancyCOincreasesafter5wks,45%by24wks,decreasestonearnormalby10daysPPSV-increasesfrom8topeakat20wks,decreasestobaselineby2wksPPPl.volume-increasesby6wks,1.5-2timesnormalbyIItrimester,plateausTBWby6-8L,Naretension-500-900meqIncreasedAorticcompliance,A-Vshunt
3、inginuterusPregnancy stresses the cardiovascular systemWorseningknownheartdisorders;mildheartdisordersmayfirstbecomeevidentduringpregnancy.DecreasedHbandincreasedbloodvolume,strokevolume,andeventuallyheartrate.Cardiacoutputincreasesby30to50%.Thesechangesbecomemaximalbetween28and34wkgestationPregnanc
4、y stresses the cardiovascular systemDuringlabor,cardiacoutputincreasesabout20%witheachuterinecontractionOtherstressesincludestrainingduringthe2ndstageoflaborandtheincreaseinvenousbloodreturningtotheheartfromthecontractinguterus!Cardiovascularstressesdonotreturntoprepregnancylevelsuntilseveralweeksaf
5、terdeliveryEffect of heart disease on fetusAbortionPretermdeliveryStillbirthFGRFetaldistressGeneticsRisk factors for cardiac failure during pregnancyInfectionAnemiaObesityHypertensionHyperthyroidismMultiplepregnancyDiagnosisDiagnosisClinicalevaluationmilddyspneasystolicmurmursjugularvenousdistention
6、tachycardiadependentedemamildcardiomegaly1 Can been found in normal pregnancy and heart disorder.2 Diastolic or presystolic murmurs are more specific for heart disordersHow do you grade the functional capacity of heart?How do you grade the functional capacity of heart?DiagnosisDiagnosisEKG:Whatareth
7、eECGchangesinpregnancy?1)LeadIIIoftenshowsaverydeepQwaveandinversionofTwave2)UnipolarleadsV2-V4mayshowflatteningofTwavewithdepressionofSTsegmentEchocardiographyX-rayEarly stage heart failureChesttightness,palpitations,shortnessofbreathafterslightactivityHR110bpmandrespiratoryrate20perminatrestAtnigh
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