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1.
Pan Afr Med J ; 35: 6, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32128022

RESUMO

Women with complex functionally univentricular hearts rarely survive into adulthood without corrective or palliative surgery. Reports of pregnancy outcome in this group of patients in resource-poor settings are sparse. We report a case of unrepaired pulmonary atresia ventricular septal defect (VSD) with major aorto-pulmonary collateral arteries (MAPCA) who survived into adulthood and was able to complete a successful pregnancy in a resource-poor country.


Assuntos
Cardiopatias Congênitas/fisiopatologia , Comunicação Interventricular/fisiopatologia , Complicações Cardiovasculares na Gravidez/fisiopatologia , Atresia Pulmonar/fisiopatologia , Adulto , Países em Desenvolvimento , Feminino , Humanos , Gravidez , Resultado da Gravidez
2.
Adv Clin Chem ; 94: 1-30, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31952570

RESUMO

Hypertensive disorders of pregnancy (HDP) is the most common and widely known as serious complication of pregnancy. As this syndrome is a major leading cause of maternal, fetal, and neonatal morbidity/mortality worldwide, many studies have sought to identify candidate molecules as potential disease biomarkers (DBMs) for use in clinical examinations. Accumulating evidence over the past 2 decades that the many proteolytic peptides appear in human humoral fluids, including peripheral blood, in association with an individual's health condition. This review provides the potential utility of peptidomic analysis for monitoring for pathophysiological status in HDP, and presents an overview of current status of peptide quantification technology. Especially, the technical limitations of the methods used for DBM discovery in the blood are discussed.


Assuntos
Hipertensão/sangue , Peptídeos/sangue , Complicações Cardiovasculares na Gravidez/sangue , Biomarcadores/sangue , Feminino , Humanos , Hipertensão/complicações , Gravidez , Complicações Cardiovasculares na Gravidez/fisiopatologia
3.
Biomed Res Int ; 2019: 5320902, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31886225

RESUMO

Pregnancy is a period in a woman's life in which changes can occur that affect different physiological processes. Common conditions during this period include vascular changes, such as lower extremity venous insufficiency (VI). This is an observational, analytical, and prospective cohort study in which 114 pregnant women were analyzed, of which 62 were clinically diagnosed with VI. In parallel, 52 control patients without VI (HC) were studied. The aim of this study was to observe changes in angiogenesis and inflammation markers as well as the presence of calcium deposits. The expression of vascular endothelial growth factor (VEGF), transforming growth factor-ß (TGF-ß), and pigment epithelium-derived factor (PEDF) was analyzed by immunohistochemistry and RT-qPCR. The presence of calcium deposits was revealed using the von Kossa method. In the placentas of mothers with VI, gene expression of VEGF (34.575 [32.380-36.720] VI vs 32.965 [30.580-36.320] HC) and PEDF (25.417 [24.459-27.675] VI vs 24.400 [23.102-30.223] HC) significantly increased, as was protein expression in the placental villi. An increase in calcium deposits was observed in the placentas of women with VI (72.58% VI/53.84% HC). This study revealed the existence of cellular damage in the placental villi of mothers with VI with tissue implications such as increased calcification.


Assuntos
Calcinose/metabolismo , Proteínas do Olho/análise , Fatores de Crescimento Neural/análise , Placenta , Complicações Cardiovasculares na Gravidez/metabolismo , Serpinas/análise , Fator A de Crescimento do Endotélio Vascular/análise , Insuficiência Venosa/metabolismo , Adolescente , Adulto , Calcinose/fisiopatologia , Proteínas do Olho/química , Proteínas do Olho/metabolismo , Feminino , Humanos , Extremidade Inferior/fisiopatologia , Fatores de Crescimento Neural/química , Fatores de Crescimento Neural/metabolismo , Placenta/irrigação sanguínea , Placenta/química , Placenta/patologia , Gravidez , Complicações Cardiovasculares na Gravidez/fisiopatologia , Estudos Prospectivos , Serpinas/química , Serpinas/metabolismo , Regulação para Cima , Fator A de Crescimento do Endotélio Vascular/química , Fator A de Crescimento do Endotélio Vascular/metabolismo , Insuficiência Venosa/fisiopatologia , Adulto Jovem
4.
Medicine (Baltimore) ; 98(48): e18170, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31770267

RESUMO

RATIONALE: The umbilical cord is the way to exchange gas, supply nutrients, excrete metabolized. Thrombosis of the umbilical cord leads to fetal hypoxia, which jeopardizes fetal health and can cause fetal death. Umbilical vessel thrombosis, which is rarely reported, is difficult to detect prenatally. PATIENT CONCERNS: Both pregnant women had an unremarkable pregnancy course until a routine ultrasound scan in the third trimester showed a single umbilical artery. However, one umbilical vein and 2 umbilical arteries were seen during an ultrasound examination at 32 weeks. Case 2 had a better pregnancy outcome because of the timely discovery of this complication. DIAGNOSIS: Both cases were diagnosed as umbilical artery thrombosis. INTERVENTIONS: The first patient received no interventions until they reported decreased fetal movements and gradually disappear. The second patient underwent an emergency cesarean section. OUTCOMES: In Case 1, an emergency ultrasound examination showed intrauterine fetal death, and the patient vaginally delivered a stillborn child weighing 3300 g in a day. In Case 2, a female neonate weighing 2860 g was delivered by cesarean section, and exhibited Apgar scores of 10 and 10 at 1 and 5 minutes. CONCLUSION: In the late-term abortions, obstetricians should be vigilant if ultrasound imaging shows suspected umbilical vascular thrombosis or shows 1 umbilical artery when there had previously been 2. The fetus should be closely monitored and interventions implemented as early as possible to improve the prenatal detection rate of umbilical vessel thrombosis and avoid adverse pregnancy outcomes.


Assuntos
Cesárea/métodos , Intervenção Médica Precoce/métodos , Morte Fetal , Complicações Cardiovasculares na Gravidez , Trombose , Artérias Umbilicais , Adulto , Serviços Médicos de Emergência/métodos , Feminino , Morte Fetal/etiologia , Morte Fetal/prevenção & controle , Monitorização Fetal/métodos , Humanos , Recém-Nascido , Gravidez , Complicações Cardiovasculares na Gravidez/diagnóstico , Complicações Cardiovasculares na Gravidez/fisiopatologia , Resultado da Gravidez , Natimorto , Trombose/complicações , Trombose/diagnóstico , Trombose/fisiopatologia , Ultrassonografia Pré-Natal/métodos , Artérias Umbilicais/diagnóstico por imagem , Artérias Umbilicais/patologia
5.
Pregnancy Hypertens ; 17: 94-99, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31487664

RESUMO

OBJECTIVES: To estimate the incidence of hypertension and the trend of systolic and diastolic blood pressure changes and relating factors influencing women with and without prior preeclampsia (PE). STUDY DESIGN: This prospective population based study included a total of 3022 eligible women (355 with PE and 2667 non-PE) recruited from participants of the Tehran Lipid and Glucose Study (TLGS) who were assessed for progression to subsequent hypertension over 15-year follow up. Pooled logistic regression model was utilized to estimate odds ratio (OR) of hypertension. The generalized estimating equation (GEE) was used to evaluate the trend of changes in hypertension parameters over time. RESULTS: At the end of follow-ups, 109 women (30.7%) in the PE group and 575 (21.5%) in the non-PE group had hypertension. The total cumulative incident rate of hypertension was 34/1000 person-years for PE groups and 22/1000 person years for non-PE groups (P < 0.001). Pooled logistic regression analysis showed that compared to non-PE women, OR of hypertension progression in women with PE was 3.70 after adjustment for age, body mass index (BMI), parity, triglycerides (TG) and high-density lipoprotein (HDL-C) (P-value < 0.001). Based on GEE analysis, mean changes of systolic and diastolic blood pressure in PE women increased by 4.66 and 2.55 mmHg, respectively, compared to the non-PE group, after adjustment for age, and BMI at baseline (P < 0.001), although the interaction term (follow-up year × PE) was not statistically significant. CONCLUSION: This study demonstrated increased chances of developing hypertension among women with prior PE, particularly in those who develop additional risk factors in their later life, compared to the non-PE women. While the trajectory of blood pressure change over time is similar between women with and without preeclampsia, women with a history of preeclampsia consistently have higher levels of blood pressure.


Assuntos
Pressão Sanguínea/fisiologia , Pré-Eclâmpsia/epidemiologia , Cuidado Pré-Natal , Adulto , Determinação da Pressão Arterial , Estudos de Coortes , Feminino , Humanos , Hipertensão/epidemiologia , Hipertensão/fisiopatologia , Incidência , Irã (Geográfico)/epidemiologia , Pessoa de Meia-Idade , Razão de Chances , Pré-Eclâmpsia/fisiopatologia , Gravidez , Complicações Cardiovasculares na Gravidez/epidemiologia , Complicações Cardiovasculares na Gravidez/fisiopatologia , Estudos Prospectivos , Adulto Jovem
6.
Biomed Res Int ; 2019: 2957429, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31355253

RESUMO

Objectives: This papers aims to investigate the association between different levels of postpartum weight retention (PPWR) and cardiometabolic risk among the Saudi women 12 months postpartum. Methods: This study is a follow-up of subgroup of cohort from Riyadh mother and baby multicenter cohort study. Clinical data were collected from participants 12 months after delivery and included current Body Mass Index (BMI), waist circumference, hip circumference, and blood pressure. In addition the following blood tests done were fasting blood glucose (FBG), glycosylated haemoglobin (HbA1c) levels, and lipids profile to assess the participants' cardiometabolic risks. The participants were categorized into three groups based on the level of PPWR: weight retention < 3kg; weight retention 3 to < 7kg; and weight retention ≥ 7kg. Subsequently, the prevalence of cardiometabolic risk factors was compared in the three groups to assess the association between different levels of PPWR and cardiometabolic risk factors. Logistic regression was used to test the effect of PPWR in the development of metabolic syndrome and Adjusted Odds Ratio (AOR) was calculated. Results: A total of 115 women participated in this study. Around 35% of the study population retained ≥ 7 kg of weight. The prevalence of cardiometabolic risk factors, including metabolic syndrome (MetS), increases with the increase of PPWR (p<0.01). The prevalence of MetS is 13% with highest frequency in the group with the highest weight retention. The determinants developing MetS were prepregnancy weight; AOR (95% CI); 1.08 (1.02-1.14), P< 0.01, current BMI, AOR (95% CI); 1.30 (1.12-1.51), P< 0.01, and FBG during pregnancy, AOR (95% CI); and 4.82 (1.72-13.48), P < 0.01. Conclusion: Increased weight retention after delivery augments the rate of occurrence of cardiometabolic risk factors. Determinants of the development of MetS in postpartum Saudi women are increased prepregnancy weight, current BMI, and FBG during pregnancy.


Assuntos
Ganho de Peso na Gestação , Complicações Cardiovasculares na Gravidez , Adulto , Feminino , Seguimentos , Humanos , Período Pós-Parto , Gravidez , Complicações Cardiovasculares na Gravidez/epidemiologia , Complicações Cardiovasculares na Gravidez/patologia , Complicações Cardiovasculares na Gravidez/fisiopatologia , Fatores de Risco , Arábia Saudita/epidemiologia
7.
Rev Cardiovasc Med ; 20(2): 53-58, 2019 Jun 30.
Artigo em Inglês | MEDLINE | ID: mdl-31344997

RESUMO

Peripartum cardiomyopathy is a type of non-ischemic cardiomyopathy with a high rate of thromboembolic events. Guiding strategies for anticoagulation in patients with peripartum cardiomyopathy and thromboembolic events are limited. Literature for all cases of peripartum cardiomyopathy with intracardiac thrombi were reviewed and summarized from twelve case reports. Based on the available literature, we conclude that patients with peripartum cardiomyopathy with ejection fraction of less than 30% should strongly consider anticoagulation therapy to avoid thromboembolic events. Future studies may be able to further elucidate the optimal indication and duration of anticoagulation.


Assuntos
Anticoagulantes/uso terapêutico , Coagulação Sanguínea/efeitos dos fármacos , Cardiomiopatias/tratamento farmacológico , Complicações Cardiovasculares na Gravidez/tratamento farmacológico , Trombose/tratamento farmacológico , Adulto , Anticoagulantes/efeitos adversos , Cardiomiopatias/sangue , Cardiomiopatias/diagnóstico , Cardiomiopatias/fisiopatologia , Feminino , Humanos , Período Periparto , Gravidez , Complicações Cardiovasculares na Gravidez/sangue , Complicações Cardiovasculares na Gravidez/diagnóstico , Complicações Cardiovasculares na Gravidez/fisiopatologia , Trombose/sangue , Trombose/diagnóstico , Trombose/fisiopatologia , Resultado do Tratamento , Adulto Jovem
8.
J Obstet Gynaecol ; 39(8): 1087-1092, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31195863

RESUMO

Studies on pregnancy with rheumatic heart disease (RHD), still common in the developing world, are relatively old and small. This retrospective study was conducted to study the outcome of pregnancy in women with RHD and factors associated with poor outcome. We studied 353 pregnancies in 273 women. In 35% of the patients, the diagnosis was first made during index pregnancy. Women with severe MS had lesser gestational age at delivery and birth weight than those with mild-to-moderate MS. Women with NYHA III-IV status delivered at lesser gestational age had lesser birth weight and had higher perinatal and maternal mortality than NYHA I-II status. Pregnancy outcome was better among women who underwent Balloon mitral valvotomy (BMV) when indicated than those who did not. Cardiac complications were higher in women with severe MS and poor NYHA status. Early booking is important for the optimal outcome. BMV is safe during pregnancy and should be done when necessary. Impact statement What is already known on this subject? Rheumatic heart disease continues to be the major cause of maternal morbidity and mortality in developing countries. Most of the recent studies discuss pregnancy with heart disease as a whole with RHD being a part. What do the results of this study add? A large number of women in developing countries conceive with unknown underlying heart disease. Late access to antenatal care is associated with poor outcome. Cardiac and obstetric complications are significantly higher in women with severe mitral stenosis and poor NYHA functional status. Balloon mitral valvotomy (BMV) during pregnancy is safe and technically feasible. BMV averts major complications that may occur due to severe disease. Patients with RHD can undergo labour and vaginal delivery under vigilant monitoring. What are the implications for clinical practice? Thorough clinical examination by the clinician at initial visit is important to detect unknown heart disease. Symptoms pointing towards underlying heart disease should prompt evaluation. This study provides evidence for population-based screening for heart disease in women. Optimal management of compensated mitral stenosis requires weighing the risks and benefits of pharmacological therapy versus BMV in the context of maternal condition. BMV should be performed when necessary.


Assuntos
Pobreza , Complicações Cardiovasculares na Gravidez/fisiopatologia , Resultado da Gravidez , Cardiopatia Reumática/complicações , Adulto , Angioplastia com Balão , Procedimentos Cirúrgicos Cardiovasculares , Países em Desenvolvimento , Feminino , Idade Gestacional , Humanos , Estenose da Valva Mitral/cirurgia , Gravidez , Cardiopatia Reumática/diagnóstico , Cardiopatia Reumática/fisiopatologia , Fatores de Risco , Resultado do Tratamento
9.
J Med Case Rep ; 13(1): 115, 2019 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-31039808

RESUMO

BACKGROUND: Hypertension is common in pregnant women presenting with aortic coarctation or Takayasu's arteritis. Uncontrolled hypertension leads to increased adverse maternal and neonatal events. CASE PRESENTATION: A 36-year-old gravida 2, para 1 Caucasian woman presented at 9 weeks of gestation with headaches but normal blood pressure. She had a past medical history of an in vitro fertilization pregnancy complicated by preeclampsia at 27 weeks of gestation (birth weight 1900 g) and infrarenal aortic stenosis. In the current pregnancy, she received aspirin and calcium as preeclampsia prophylaxis, remained normotensive throughout pregnancy, and was delivered by elective cesarean section at 37 weeks without complications. CONCLUSIONS: This case demonstrates a significant chronic aortopathy in pregnancy with normal fetal growth and uterine blood flow through collateral supply from the internal mammary and epigastric arteries.


Assuntos
Estenose da Valva Aórtica/diagnóstico por imagem , Aspirina/uso terapêutico , Hormônios e Agentes Reguladores de Cálcio/uso terapêutico , Cálcio/uso terapêutico , Inibidores da Agregação de Plaquetas/uso terapêutico , Pré-Eclâmpsia/prevenção & controle , Complicações Cardiovasculares na Gravidez/diagnóstico por imagem , Adulto , Estenose da Valva Aórtica/fisiopatologia , Estenose da Valva Aórtica/prevenção & controle , Cesárea , Angiografia por Tomografia Computadorizada , Feminino , Cefaleia , Humanos , Pré-Eclâmpsia/tratamento farmacológico , Gravidez , Complicações Cardiovasculares na Gravidez/fisiopatologia , Complicações Cardiovasculares na Gravidez/prevenção & controle , Resultado da Gravidez , Proteinúria
10.
J Ayub Med Coll Abbottabad ; 31(2): 276-278, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31094131

RESUMO

Accessory mitral valve tissue is a rare congenital anomaly that is commonly incidentally diagnosed. When symptomatic, it tends to present with features of left ventricular outflow (LVOT) obstruction in about two thirds of cases. It is also commonly associated with other congenital anomalies, notably ventricular septal defects. Transthoracic echocardiography is a very useful diagnostic test to make a diagnosis and its widespread use will increase detection of this condition. We are presenting a case of a 29-year-old lady who presented with breathlessness in the third trimester of pregnancy and was subsequently found to have evidence of accessory mitral valve tissue on echocardiography.


Assuntos
Cardiopatias Congênitas , Valva Mitral , Complicações Cardiovasculares na Gravidez , Adulto , Dispneia/etiologia , Ecocardiografia , Feminino , Cardiopatias Congênitas/complicações , Cardiopatias Congênitas/diagnóstico por imagem , Cardiopatias Congênitas/fisiopatologia , Humanos , Valva Mitral/anormalidades , Valva Mitral/diagnóstico por imagem , Gravidez , Complicações Cardiovasculares na Gravidez/diagnóstico por imagem , Complicações Cardiovasculares na Gravidez/fisiopatologia
11.
PLoS One ; 14(5): e0216477, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31141530

RESUMO

BACKGROUND: Maternal hypertension, type 2 diabetes (T2D) and obesity are associated with an increased risk of having offspring with conotruncal heart defects (CTDs). Prior studies have identified sets of single nucleotide polymorphisms (SNPs) that are associated with risk for each of these three adult phenotypes. We hypothesized that these same SNPs are associated with maternal risk of CTDs in offspring. METHODS AND RESULTS: We evaluated the parents of children with a CTD ascertained from the Children's Hospital of Philadelphia (n = 466) and by the Pediatric Cardiac Genomic Consortium (n = 255). We used a family-based design to assess the association between CTDs and the maternal genotype for individual hypertension, T2D, and obesity-related SNPs and found no association between CTDs and the maternal genotype for any individual SNP. In addition, we calculated genetic risk scores (GRS) for hypertension, T2D, and obesity using previously published GRS formulas. When comparing the GRS of mothers to fathers, there were no statistically significant differences in the mean for the combined GRS or the GRS for each individual condition. However, when we categorized the mothers and fathers of cases with CTDs as having high (>95th percentile) or low (≤95th percentile) scores, compared to fathers, mothers had almost two times the odds of having a high GRS for hypertension (OR 1.7, 95% CI 1.0, 2.8) and T2D (OR 1.8, 95% CI 1.1, 3.1). CONCLUSIONS: Our results support a link between maternal genetic risk for hypertension/T2D and CTDs in their offspring. These associations might be independent of maternal phenotype at conception.


Assuntos
Diabetes Mellitus Tipo 2/genética , Cardiopatias Congênitas/genética , Hipertensão/genética , Polimorfismo de Nucleotídeo Único , Complicações Cardiovasculares na Gravidez/genética , Gravidez em Diabéticas/genética , Adulto , Diabetes Mellitus Tipo 2/patologia , Diabetes Mellitus Tipo 2/fisiopatologia , Feminino , Cardiopatias Congênitas/patologia , Cardiopatias Congênitas/fisiopatologia , Humanos , Hipertensão/patologia , Hipertensão/fisiopatologia , Masculino , /fisiopatologia , Gravidez , Complicações Cardiovasculares na Gravidez/patologia , Complicações Cardiovasculares na Gravidez/fisiopatologia , Gravidez em Diabéticas/patologia , Gravidez em Diabéticas/fisiopatologia , Fatores de Risco
13.
Ann Vasc Surg ; 59: 313.e1-313.e3, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31009730

RESUMO

BACKGROUND: Pregnancy is a hypercoagulable state associated with a fivefold increase in the risk of venous thromboembolism. Thrombolysis is the preferred level of care for patients with acute iliofemoral deep vein thrombosis (DVT); however, most studies exclude pregnant patients, highlighting the lack of data regarding the efficacy and safety of thrombolytic therapy for mother and fetus. METHODS: We describe the successful use of thrombolytic therapy in conjunction with ultrasound to remove a large ileofemoral DVT in a first-trimester patient with phlegmasia cerulea dolens. The procedure was performed safely for both mother and fetus. RESULTS: No radiation or contrast dye was used, and intravascular ultrasound confirmed patency of the entirety of the venous system. She delivered a healthy term baby after the procedure and had no further sequalae. CONCLUSION: Thrombolysis with intravascular ultrasound may be considered in first-trimester pregnant patients with threatened limb due to DVT.


Assuntos
Veia Femoral/efeitos dos fármacos , Fibrinolíticos/administração & dosagem , Veia Ilíaca/efeitos dos fármacos , Complicações Cardiovasculares na Gravidez/tratamento farmacológico , Terapia Trombolítica , Tromboflebite/tratamento farmacológico , Feminino , Veia Femoral/diagnóstico por imagem , Veia Femoral/fisiopatologia , Humanos , Veia Ilíaca/diagnóstico por imagem , Veia Ilíaca/fisiopatologia , Nascimento Vivo , Gravidez , Complicações Cardiovasculares na Gravidez/diagnóstico por imagem , Complicações Cardiovasculares na Gravidez/fisiopatologia , Primeiro Trimestre da Gravidez , Tromboflebite/diagnóstico por imagem , Tromboflebite/fisiopatologia , Resultado do Tratamento , Ultrassonografia de Intervenção , Ultrassonografia Pré-Natal/métodos , Grau de Desobstrução Vascular
14.
J Gynecol Obstet Hum Reprod ; 48(6): 431-434, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30905853

RESUMO

Posterior reversible encephalopathy syndrome (PRES) and reversible cerebral vasoconstriction (RCVS) are rare neurological disorders with complex physiopathology which is not yet fully understood. We present here the case of a 31-year-old woman with a bi-amniotic bi-chorial pregnancy who developed immediate postpartum eclampsia after vaginal delivery, associated with RCVS and PRES. Although post-partum is a well-known precipitating factors for these diseases, to our knowledge, there are only few similar cases reported with the association of these syndromes. Repeated MRI scans were instrumental in the final diagnosis of RCVS associated with PRES, allowing us to give the patient the appropriate treatment. These two syndromes have similar symptoms but may have different treatments, thus highlighting the importance of a correct diagnosis.


Assuntos
Doenças Arteriais Cerebrais/complicações , Eclampsia/diagnóstico , Síndrome da Leucoencefalopatia Posterior/complicações , Transtornos Puerperais/diagnóstico , Vasoconstrição , Adulto , Doenças Arteriais Cerebrais/diagnóstico , Doenças Arteriais Cerebrais/tratamento farmacológico , Eclampsia/fisiopatologia , Feminino , Cefaleia , Humanos , Nimodipina/uso terapêutico , Síndrome da Leucoencefalopatia Posterior/diagnóstico , Gravidez , Complicações Cardiovasculares na Gravidez/fisiopatologia , Gravidez de Gêmeos , Transtornos Puerperais/tratamento farmacológico , Transtornos Puerperais/fisiopatologia , Hemorragia Subaracnóidea/complicações , Hemorragia Subaracnóidea/diagnóstico , Síndrome , Vasodilatadores
15.
PLoS One ; 14(2): e0211857, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30785920

RESUMO

BACKGROUND: Peripartum cardiomyopathy (PPCM) is a serious cardiac disorder occurring late in pregnancy or early in the postpartum period. We examined associations between hypertensive disorders of pregnancy (HDP: preeclampsia and gestational hypertension) and PPCM, accounting for other pregnancy-related risk factors for PPCM. METHODS: Using nationwide Danish register data, we constructed a cohort of all women with ≥1 live birth or stillbirth in Denmark between 1978 and 2012. Using log-linear binomial regression and generalized estimating equations, we estimated risk ratios (RRs) for PPCM associated with HDP of varying severity. RESULTS: In a cohort of 1,088,063 women with 2,078,822 eligible pregnancies, 126 women developed PPCM (39 in connection with an HDP-complicated pregnancy). The risks of PPCM were significantly higher in women with HDP-complicated pregnancies than in women with normotensive pregnancies (severe preeclampsia, RR 21.2, 95% confidence interval [CI] 12.0-37.4; moderate preeclampsia, RR 10.2, 95% CI 6.18-16.9; gestational hypertension, RR 5.16, 95% CI 2.11-12.6). The RRs for moderate preeclampsia and gestational hypertension were not significantly different from one another (p = 0.18); the RR for severe preeclampsia was significantly different from the RR for moderate preeclampsia and gestational hypertension combined (p = 0.02). CONCLUSIONS: Although 70% of PPCM occurred in women with normotensive pregnancies, HDPs were associated with substantial increases in PPCM risk that depended on HDP severity. The heart's capacity to adapt to a normal pregnancy may be exceeded in some women already susceptible to cardiac insult, contributing to PPCM. HDPs, severe preeclampsia in particular, probably represent an additional cardiac stressor during pregnancy.


Assuntos
Cardiomiopatias/epidemiologia , Hipertensão Induzida pela Gravidez/epidemiologia , Pré-Eclâmpsia/epidemiologia , Complicações Cardiovasculares na Gravidez/epidemiologia , Adulto , Cardiomiopatias/etiologia , Cardiomiopatias/fisiopatologia , Dinamarca , Feminino , Humanos , Hipertensão Induzida pela Gravidez/fisiopatologia , Período Periparto/fisiologia , Período Pós-Parto/fisiologia , Pré-Eclâmpsia/fisiopatologia , Gravidez , Complicações Cardiovasculares na Gravidez/fisiopatologia , Resultado da Gravidez , Fatores de Risco
17.
Clin Res Cardiol ; 108(8): 831-846, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30806769

RESUMO

Hormones have a vital duty in the conservation of physiological cardiovascular function during pregnancy. Alterations in oestrogen, progesterone and prolactin levels are associated with changes in the cardiovascular system to support the growing foetus and counteract pregnancy stresses. Pregnancy hormones are, however, also linked to numerous pathophysiological outcomes on the cardiovascular system. The expression and effects of the three main pregnancy hormones (oestrogen, prolactin and progesterone) vary depending on the gestation period. However, the reaction of a target cell also depends on the abundance of hormone receptors and impacts put forth by other hormones. Hormonal interaction may be synergistic, antagonistic or permissive. It is crucial to explore the cross talk of pregnancy hormones during gestation, as this may have a greater impact on the overall changes to the cardiovascular system.


Assuntos
Doenças Cardiovasculares/sangue , Sistema Cardiovascular/metabolismo , Estradiol/sangue , Hemodinâmica/fisiologia , Complicações Cardiovasculares na Gravidez/sangue , Progesterona/sangue , Prolactina/sangue , Biomarcadores/sangue , Doenças Cardiovasculares/fisiopatologia , Feminino , Humanos , Gravidez , Complicações Cardiovasculares na Gravidez/fisiopatologia
18.
Int J Cardiol ; 276: 177-184, 2019 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-30497895

RESUMO

BACKGROUND: Peripartum cardiomyopathy (PPCM) is an important cause of pregnancy-associated heart failure, which appears in previously healthy women towards the end of pregnancy or within five months following delivery. Although the ECG is widely used in clinical practice, its prognostic value has not been established in PPCM. METHODS: We analysed 12-lead ECGs of patients with PPCM, taken at index presentation and follow-up visits at 6 and 12 months. Poor outcome was determined by the composite endpoint of death, readmission, NYHA functional class III/IV or left ventricular ejection fraction (LVEF) of ≤35% at follow-up. RESULTS: This cohort of 66 patients had a median age of 28.59 (IQR 25.43-32.19). The median LVEF at presentation (33%, IQR 25-40) improved significantly at follow-up (LVEF 49%, IQR 38-55, P < 0.001 at 6 months; 52% IQR 38-57, P = 0.001 at 12 months). Poor outcome occurred in 27.91% at 6 months and 41.18% at 1 year. Whereas sinus tachycardia at baseline was an independent predictor of poor outcome at 12 months (OR 6.56, 95% CI 1.17-20.41, P = 0.030), sinus arrhythmia was associated with event free survival (log rank P = 0.013). T wave inversion was associated with an LVEF ≤35% at presentation (P = 0.038), but did not predict poor outcome. A prolonged QTc interval at presentation (found in almost half of the cohort) was an independent predictor of poor outcome at 6 months (OR 6.34, 95% CI 1.06-37.80, P = 0.043). CONCLUSION(S): A prolonged QTc and sinus tachycardia at baseline were independent predictors of poor outcome in PPCM at 6 months and 1 year respectively.


Assuntos
Cardiomiopatias/fisiopatologia , Eletrocardiografia/métodos , Período Periparto/fisiologia , Complicações Cardiovasculares na Gravidez/fisiopatologia , Adulto , Cardiomiopatias/diagnóstico por imagem , Cardiomiopatias/epidemiologia , Estudos de Coortes , Feminino , Seguimentos , Insuficiência Cardíaca/diagnóstico por imagem , Insuficiência Cardíaca/epidemiologia , Insuficiência Cardíaca/fisiopatologia , Humanos , Gravidez , Complicações Cardiovasculares na Gravidez/diagnóstico por imagem , Complicações Cardiovasculares na Gravidez/epidemiologia , Prognóstico , Método Simples-Cego , África do Sul/epidemiologia
19.
Trends Cardiovasc Med ; 29(3): 164-173, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30111492

RESUMO

Peripartum cardiomyopathy (PPCM) is a potentially life-threatening pregnancy-associated disease that typically arises in the peripartum period. While the disease is relatively uncommon, its incidence is rising. It is a form of idiopathic dilated cardiomyopathy, defined as pregnancy-related left ventricular dysfunction, diagnosed either towards the end of pregnancy or in the months following delivery, in women without any other identifiable cause. The clinical presentation, diagnostic assessment and treatment usually mirror that of other forms of cardiomyopathy. Timing of delivery and management require a multidisciplinary approach and individualization. Subsequent pregnancies generally carry risk, but individualization is required depending on the pre-pregnancy left ventricular function. Recovery occurs in most women on standard medical therapy for heart failure with reduced ejection fraction, more frequently than in other forms of nonischemic cardiomyopathy. The purpose of this review is to summarize the current state of knowledge with regard to diagnosis, treatment and management, with a focus on long term implications.


Assuntos
Cardiomiopatia Dilatada/tratamento farmacológico , Fármacos Cardiovasculares/uso terapêutico , Complicações Cardiovasculares na Gravidez/tratamento farmacológico , Transtornos Puerperais/tratamento farmacológico , Disfunção Ventricular Esquerda/tratamento farmacológico , Cardiomiopatia Dilatada/diagnóstico , Cardiomiopatia Dilatada/epidemiologia , Cardiomiopatia Dilatada/fisiopatologia , Fármacos Cardiovasculares/efeitos adversos , Feminino , Humanos , Período Periparto , Gravidez , Complicações Cardiovasculares na Gravidez/diagnóstico , Complicações Cardiovasculares na Gravidez/epidemiologia , Complicações Cardiovasculares na Gravidez/fisiopatologia , Resultado da Gravidez , Transtornos Puerperais/diagnóstico , Transtornos Puerperais/epidemiologia , Transtornos Puerperais/fisiopatologia , Recuperação de Função Fisiológica , Fatores de Risco , Volume Sistólico/efeitos dos fármacos , Fatores de Tempo , Resultado do Tratamento , Disfunção Ventricular Esquerda/diagnóstico , Disfunção Ventricular Esquerda/epidemiologia , Disfunção Ventricular Esquerda/fisiopatologia , Função Ventricular Esquerda/efeitos dos fármacos
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