Pregnancy should be how to treat heart disease

Pregnant women in custody heart disease

Indications of a termination of pregnancy: the original heart of women must be tolerance of pregnancy in the original number of factors such as the type of heart disease complications of heart conditions, such as whether heart disease in pregnant women to assess the ability of tolerance when the pregnancy is required Thinking carefully heart of pregnancy may increase the burden of life-threatening also need to avoid excessive worries which will rise to the loss of reproductive opportunities where any of the following are generally not suitable for early termination of pregnancy: ① heart disease changed heavier heart function Ⅲ level or above had history of heart failure Persons; ② rheumatic heart disease pulmonary hypertension associated with chronic atrial fibrillation or a high degree atrioventricular block the near future, with bacterial endocarditis; ③ congenital heart disease marked cyanosis, or pulmonary hypertension; ④ merger of other more serious diseases such as renal Yan severe hypertension such as tuberculosis, but the pregnancy has been more than three months generally do not consider terminating the pregnancy because of the sick at heart, their risk of pregnancy termination of pregnancy if no less than to have taken place in heart failure is still suitable time of termination of pregnancy

2 to continue the pregnancy care: heart failure is the fatal heart attack pregnant women and heart load capacity of plasma because of the declaration and has physiological changes such as increased consumption and increased compensation and lead to heart failure and dysfunction of the major aspects of care during pregnancy therefore the purpose of strengthening Lies in the prevention of heart failure and specific measures can be summarized in order to alleviate the burden and improve heart function of the two compensatory heart

(1) reduce the burden of heart: should pay attention to the following:

1) increase the limit physical activity daily rest period of at least ensure that 10 to 12 hours of sleep as much as possible from the left lying in order to increase the volume and cardiac output to maintain the stability of Huixin

2) to maintain the spirit of avoiding emotional feeling

3) into the high-protein eating less fat and more vitamin daily intake limit sodium salt 3 ~ 5 g prevent nutritional edema reasonable weight control so that the rate of increase of not more than 0.5 kg per week throughout the pregnancy does not exceed 10 kg

4) Elimination of damage to heart function of various factors such as anemia hypoproteinemia lack of vitamin B1 in particular with pregnancy-induced hypertension

5) For a small amount of blood many times (150 ~ 200 ml); For rehydration limited to 500 ~ 1 000ml / d, Disu <10 to 15 drops / min

(2) compensatory increase heart function: including the following:

1) cardiovascular surgery: a heavier heart disease Ⅲ ~ Ⅳ non-surgical anesthesia Yaoqiubugao can be complicated pregnancy three to four months to carry out emergency separation of the mitral valve (mitral stenosis simply caused acute pulmonary edema) Can be implemented in the pre-closure artery catheter in patients with heart failure occurred during or arterial catheter infections are surgical indications

2) digitalis: the heart of pregnant women without signs and symptoms of heart failure in general do not need at this time because of digitalis treatment does not work Moreover, digitalis of digitalis can not guarantee that pregnancy is not in production in case of heart failure caused by reaction at that time What is more difficult to increase drug digitalis and can be rapidly within a few minutes of play as it is not difficult to closely observe the severity of heart failure early control in a timely and there was usually only sign of heart failure in the event of early symptoms of heart failure or heart function during pregnancy Ⅲ grade 28 To 32 weeks (during pregnancy hemodynamics before the peak load) of digitalis on pregnant women because of the tolerance of digitalis poisoning is less easy to choose to rapid preparations such as acetyl Mao spent glycoside (West to Portland) or poisonous flower hair Glycosides K drugs (drug Mao Xuan Hanako glycosides K) maintenance treatment is optional rapid excretion of digoxin in general to use four to six weeks postpartum blood circulation have resumed normal

In addition heart function Ⅰ-grade Ⅱ of pregnant women should increase the number of prenatal care at least 20 weeks before every two weeks by the Department of Obstetrics heart checked after the doctor once a week, if necessary, in addition to follow-up observation of family cases of major obstetric understanding of cardiac function and various compensatory Symptoms regular ECG echocardiography to facilitate the conditions for a comprehensive estimate unusual sign of a heart failure patient treatment immediately pre-production period of two weeks before the admission of the labor can be fully observe the rest also facilitates the inspection function Ⅲ Fanxin level or heart failure Patient treatment and should stay in hospital awaiting delivery

Childbirth and the postpartum period of treatment

1 delivery options: heart disease pregnant women delivery depends primarily on cardiac function and obstetric cases

(1) cesarean section: cesarean section may be the end of maternity leave in a relatively short time to avoid prolonged uterine contraction caused by changes in blood flow dynamics to reduce fatigue and pain caused by the heart load In addition, continuous epidural anesthesia for surgery Blood pressure in pregnant women mean arterial blood pressure and heart rate changes than by vaginal delivery for the surgery, however small increase in infections and bleeding to surgery itself is a burden so when the reasons for the existence of obstetric (such as fetal abnormalities Abnormal Fetal Position larger, and so on) can be properly Cesarean section indications relaxed but only in heart function Ⅲ ~ Ⅳ-level activities of rheumatic fever pulmonary hypertension coarctation of the aorta or pulmonary congestion, and so on down selective cesarean section before the operation and postoperative care after heart anti-infection, etc. Security operation is indispensable to ensure that the important measures

(2) vaginal delivery: cardiac function Ⅰ ~ Ⅱ grade unless there are obstetric complications in principle by vaginal delivery heart of the average middle-pregnant women and pregnant women compared to normal but no significant differences must be responsible for close monitoring by hand after the selection of antibiotics to prevent infection The question of maternal admission to the semi-supine and oxygen such as strong labor pains Nanren contractions can be set for droperidol (pethidine) 50 ~ 100 mg intramuscular injection, or by continuous epidural anesthesia can reduce pain and help section Second stage of the treatment of heart rate and strict observation of the respiratory rate per hour in the first stage of measurement once in the second stage of a measured every 10 minutes during intermittent contractions such as heart rate> 100 / points on both sides of the lung or the end of a small wetland La - And a mild shortness of breath is a sign of severe heart failure should be immediately digitalis intravenous injection of acetylcholine to spend glycoside or drug Mao Mao spent glycosides K question, and so I Palace after the entire fetal head a high level appropriate to that operation to shorten delivery The second stage of congenital heart disease who have left to right shunt more fetal movements should be avoided breath before shoulder delivered immediately after the injection of morphine 10 mg oxytocin 10 u delivered the placenta after abdominal pressure sand bags (1 kg weight) closely monitor blood pressure and pulse of the uterus shrink change Records of cases of vaginal bleeding

2 puerperium handling points: As a result of increased production during pregnancy and when the custody of the smooth clearance but more relaxed postpartum care if it is likely effort According to statistics 75 percent of maternal deaths occurred in heart attack early puerperal

(1) to prevent infection with antibiotics to prevent sub-acute bacterial endocarditis occurred

(2) had the maternal heart failure should continue to take strong heart drug

(3) pay attention to the pulse of breathing and body temperature changes in blood pressure and uterine bleeding in shrink -

(4) post-partum bed rest 24 to 72 hours of severe maternal heart disease should take to reduce the semi-supine Huixin blood and oxygen without heart failure performance activities are encouraged to get up early heart failure who are bed rest period should be more activities to prevent lower limb Thrombophlebitis

(5) cardiac function Ⅲ level and above is not lactating postpartum mothers breast-feeding to increase metabolism and the amount of illness will need to increase

(6) post-natal hospital for observation for at least two weeks to be improved heart function after only be discharged after discharge still rest of strict restrictions on activities of contraception

The treatment of heart failure

Non-pregnant women with heart failure and pregnancy are similar for heart failure treatment principle

(1) cardiac: Quick digitalis preparations to improve the situation of myocardial acetyl Mao preferred to spend glycosides with 0.4 mg and 25 percent glucose 20 ml slow intravenous injection required two to four hours after the addition of 0.2 ~ 0.4 mg total amount available to 1.2mg can also be used poison Mao spent glycosides K0.25mg increase of 25 percent glucose 20 ml slow intravenous necessary two to four hours after the injection of 0.125 ~ 0.25 mg appropriate digitalis volume was 0.5 mg after work to serve the rapid excretion Digoxin pregnant women to maintain strong heart drug digitalis category of the poor tolerance to be closely observing whether toxic symptoms

(2) diuretic: commonly used furosemide 40 ~ 60 mg intravenous diuretic and to reduce the circulation of blood volume and reduce the repeated use of pulmonary edema can be subject to the attention of electrolyte balance

(3) Vasodilators: heart failure when there are peripheral to the heart contraction increased load increased after the application of vasodilative drugs can play a "bleeding" in selected isosorbide dinitrate 5 ~ 10 mg mercapto Jiabing Des Voeux acid 12.5 mg or droperidol Triazine 1 mg three times a day

(4) sedation: small doses of morphine (5 mg) diluted intravenous sedation analgesia not only inhibit the over-excited respiratory center and the expansion of peripheral reduce the load of the heart before and after the anti-arrhythmia and can be used for acute left ventricular failure pulmonary edema rescue

(5) Huixin reduce blood volume: tourniquet pressure limbs rotation every five minutes release a semi-supine limbs and feet can play the same role down

(6) antiarrhythmic: arrhythmia can also be induced by heart failure caused by severe heart failure or increase should promptly corrected the rapid rhythm of ectopic Conversion with electric shocks can also be safe and effective choice for Dingpuluka Amine, such as rapid Room ectopic rhythm more use of lidocaine hydrochloride America West Law (slow rhythm) phenytoin latter particularly applies to a high degree of digitalis poisoning or complete atrioventricular block in principle can also install a temporary pacemaker intravenous drip Note Isoproterenol