Peripartum心肌病

什么是围产期心肌病?

Peripartum cardiomyopathy (PPCM), also known as postpartum cardiomyopathy, is an uncommon form of 心脏衰竭 that happens towards the end of pregnancy or in the months following de肝y, 当找不到其他心力衰竭的原因时. PPCM is most commonly diagnosed in the last month of pregnancy and the weeks following de肝y but can occur up to five months into the postpartum period. PPCM is diagnosed in individuals without a prior diagnosis of heart disease. 心肌病 means heart muscle disease but is often described as heart muscle weakness.

在PPCM中，心室扩大，心肌减弱. This causes a decrease in the amount of blood the heart pumps with each heartbeat. The amount of blood ejected from the heart with each contraction is called the left ventricular 射血分数 (LVEF), 或简称射血分数(EF). A weakened heart may have a lower EF which can cause fatigue and low blood pressure due to less blood flow to the body, and can cause swelling in legs and abdomen due to fluid buildup in organs including the lungs and 肝. 

如何诊断??

PPCM可能难以检测，因为 心力衰竭的症状 can mimic those of pregnancy, such as shortness of breath and swelling in the feet and legs. 任何新的呼吸短促, 尤其是在休息的时候, or swelling that occurs after de肝y or sudden onset of these symptoms during pregnancy should lead to prompt evaluation. 

During a physical exam, health care professionals will look for signs of fluid in the lungs. 他们可以用x光检查, 或者用听诊器来听, 肺部有积液的证据, 心跳加快或心音不正常. 一种心脏超声，叫做安 超声心动图, can detect cardiomyopathy by showing that the heart function is weak. 也可进行实验室检查以确认诊断.

当满足以下三个标准时，诊断为PPCM:

1. 心脏衰竭 develops in the last month of pregnancy or within months following de肝y.
2. 心脏泵血减少，左心室收缩 射血分数 小于45%(通常通过超声心动图测量). 正常的LVEF在50%到70%之间.
3. 没有发现其他导致心力衰竭的原因.

实验室血液检查是评估的标准部分. 这包括评估肾脏的检查, 电解质, 肝, thyroid function and a complete blood count to look for anemia or evidence of infection. 其他血液检查, brain natriuretic peptide (BNP) and N-terminal pro-BNP levels may be done to evaluate cardiac injury, 压力和风险水平.

这种情况的症状包括:

• Shortness of breath or breathlessness with light activity and when lying flat
• 乏力
• 液体潴留导致脚踝或脚肿胀, 咳嗽, 胸部充血，夜间小便增多.
• 胸痛或胸闷
• Sensation of heart racing or skipping beats (palpitations), lightheadedness or almost fainting.

It's important to talk to a health care professional if you are concerned that you have symptoms of PPCM. 

原因是什么??

根本原因尚不清楚，可能涉及几个因素. 研究表明，PPCM可能由先前的病毒性疾病引发, 营养不良, 妊娠期血液动力学压力或免疫反应异常. 这些原因尚未得到证实.

More recent research suggests that PPCM may be caused by the overactivity of certain hormones that cause damage to the vascular system. 这些激素水平在有 子痫前期, which could help explain why they are at higher risk of developing PPCM. It is not clear why some women may be more predisposed to the effects of these hormones than others. 遗传或家族史也可能起作用, although most women who develop PPCM have no family history of cardiomyopathy.

几个风险因素包括:

• 母亲年龄35岁以上
• 高血压包括先兆子痫或妊娠高血压
• 多胎妊娠(e.g.双胞胎)
• PPCM在黑人患者中更为常见, though it is not understood how race plays a role in the development of PPCM

如何治疗PPCM?

The goal of peripartum cardiomyopathy treatment is to improve heart function and keep extra fluid from collecting in the lungs or other parts of your body. 通过药物治疗, many women with PPCM recover normal heart function within the first three to six months of treatment. A small number of patients with PPCM will develop severe 心脏衰竭 requiring mechanical heart pumps or heart transplant.

A physician can prescribe several classes of medications to treat symptoms and help the heart function recover. 以下药物通常用于治疗心力衰竭. 然而, health care professionals will be cautious about using the medications as some are harmful if your are pregnant or breastfeeding.

• 血管紧张素转换酶 抑制剂/血管紧张素受体阻滞剂 -降低血压，帮助心脏更有效地工作.
• 血管紧张素受体/neprilysin抑制剂(ARNI 降低血压，使心脏更容易供血.
• β-受体阻滞药 -使心脏跳动更慢，以便有恢复线上电子游戏飞禽走兽.
• 利尿剂 -减少液体潴留.
• 洋地黄 -加强心脏的泵血能力, 但由于安全范围狭窄，需要监测水平, 它不常被使用. 
• 抗凝血剂 -帮助稀释血液. PPCM患者发生血栓的风险增加, 特别是当射血分数很低的时候.
• 变力的疗法 – Used in intensive care and for advanced 心脏衰竭 to help the heart beat stronger.
• 溴麦角环肽 -阻断催乳素的释放，催乳素是一种促进泌乳的激素. 溴麦角环肽 may help the heart recover, but the recommendations for use are not specific. Additional research is needed to understand if bromocriptine should be prescribed for patients with severe PPCM.

卫生保健专业人员可能会推荐低盐饮食, 液体限制和每日体重测量. A weight gain of 3 pounds or more over a day or two may signal a fluid buildup.

吸烟和饮酒的妇女将被建议停止, 因为这些习惯会让情况变得更糟.  

女性如何将风险降到最低?

Woman can manage their health to decrease the risk of high blood pressure. 不要吸烟. Eat a well balance diet, avoid alcohol and move daily for exercise and to support a healthy heart. Some of the risk factors for PPCM are not modifiable, such as race and genetics. Women who develop peripartum cardiomyopathy are at high risk of developing the same condition with future pregnancies, 如果心脏功能没有完全恢复. You and your health care professional might consider options for contraception if you want to avoid an unplanned pregnancy.