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1、pregnant complicated heart disease,Serious heart disease complicating pregnancy approximately 1% Significant impact on both maternal and fetal morbidity and mortality The second main cause of maternal death,General information,Normal Physiologic Changes During Gestation Heart and Blood vessels 1.Blo
2、od Volume changes beginning slowly increases at first trimester Sharply increases at 20 weeks 30 weeks reached a plateau peaked around 40 weeks,2.Cardiac Output Starts to increase around ten weeks Reaches a plateau near the end of the second trimester(30%-50%) Increase in stroke volume Rise in heart
3、 rate,3.Blood Pressure and System Vascular Resistence Decrease in systemic vascular resistance (SVR) Systolic and diastoic pressures fall throughout the first two trimesters reaching a nadir 24-28 weeks(5-10mmHg) Increasing to non-pregnant levels at term,4.Effect on Fetus Abortion Preterm labor Stil
4、l birth FGR fetal distress in uterine Perinatal Mortality Effect of medications on fetus Congenital heart lesions,5.Classification of heart disease According to Before and after diagnosis (1) Pre-existing disease. The disease antedates and is known before pregnancy (2) Disease that is first recognis
5、ed or has its onset during pregnancy( myocardial infarction) (3) Pregnancy specific disease peripartum cardiomyopathy.,According to cause of disease (1)Congenital:Cyanosis; Non-cyanosis septal defect Patent ductus arteriosus (2)acquired： rheumatic ; myocarditis (3) Idiopathetic：peripartum cardiomyop
6、athy pulmonary hypentension,According to mortality risk Group :mortality1% Atrial septal defect 房缺 Ventricular septal defect 室缺 Patent ductus arteriosus 动脉导管未闭 Pulmonic disease 肺动脉疾病 Corected tetralogy of fallot 法乐氏四联症（可矫正） Porcine valve 生 物 瓣 膜 Mitral stenosis 二尖瓣狭窄（心功I、II级）,Group :mortality 5-15%
7、Mitral stenosis with atrial fibrillation (二尖瓣狭窄伴房颤) Coarctation of aorta, uncomplicated (主动脉缩窄,无并发症） Marfans syndrome with normal aorta (马方综合征,动脉正常） Mitral valve regurgitation 二尖瓣膜关闭不全（心功III、IV级） Aortic stenosis (主动脉瓣狭窄) Artificial valve （机械瓣膜） Previous myocardial infarction （心肌梗死史 ） uncorected tetr
8、alogy of fallot,Group :mortality 25-50% Pulmonary hypertension 肺动脉高压 Marfans syndrome with aortic involvement 马方综合征（主动脉受损） Coarctation of aorta, complicated 主动脉瓣缩窄（伴并发症） From: American College of Obstetricians and Gynecologisis Cardiac disease in pregnancy,Diagnosis,History Symptoms Examination EKG
9、ecocardiogram heart function evaluation Chest Radiography,1. History,(1) history of heart disease, type of disease, treatment through. (2) whether the failure with or without incentives. (3) whether the palpitations after pregnancy ，fatigue, shortness of breath, cyanosis (4) ability to perform house
10、hold chores or work. (5) used in 2 weeks digitalis preparations, should be asked usage, dosage and withdrawal situation.,2. Clinical Manifestations,(1) visual examination: whether the cyanosis, dyspnea, jugular vein engorgement, edema, anemia. (2) cardiopulmonary examination: whether to expand the h
11、eart, with or without noise, noise location, nature, extent, heart rate (3) abdomen: ascites, hepatomegaly is touched.,3. Auxiliary Examination,(1) blood (2) chest X-ray examination (3) ECG: routine examination. (4) Holter monitoring (Holter testing): According to the results of electrocardiogram de
12、cision. (5) echocardiography (6) enzymes,4. Classification Of Cardiac Function,Objective Assessment （1994） A. No objective evidence of cardiovascular disease (无心血管病的客观依据.) B. Objective evidence of minimal cardiovascular disease (客观检查表明属于轻度心血管病患者) C. Objective evidence of moderately severe cardiovasc
13、ular disease (属于中度心血管病者) D. Objective evidence of severe cardiovascular disease (属于重度心血管病者) （其中轻中重没有明确规定） *The Criteria Committee of the New York Heart Association. Nomenclature and Criteria for Diagnosis of Diseases of the Heart and Great Vessels. 9th ed. Boston, Mass: Little, Brown 1994:253-256.,5
14、. The Diagnosis Of Heart Failure,Early Performance: 1) Low activity that is chest tightness, shortness of breath and palpitations. 2) resting heart rate 100 beats / min, respiration 20 times / min. 3) The night orthopnea because of tightness in the chest ,or to the window for breathing fresh air 4)
15、The continuity of the bottom of a small amount of lung wet tone.,Heart Failure Performance 1) orthopnea or legs hanging on the bed to be sitting. 2) shortness of breath, cyanosis, cough, hemoptysis or bloody sputum foam. 3) jugular vein engorgement, hepatomegaly, jugular venous return and positive s
16、igns of liver. 4) The continuity of the bottom of the wet lung tone.,Principles Of Treatment,1. Indications For Termination Of Pregnancy (1) cardiac function grade III or above. (2) a history of heart failure, or heart disease with pulmonary hypertension secondary. (3) cyanotic congenital heart disease, especially the right to left shunt congenital heart disease and those
