文档介绍：围产期心肌病 Peripartum Cardiomyopthy, PPCM
Sliwa K, Hilfiker-Kleiner D, Petrie M C, et al. Heart Failure Association of the European Society of Cardiology Working Group on Peripartum Cardiomyopathy. Current state of knowledge on aetiology, diagnosis, management, and therapy of peripartum cardiomyopathy: a position statement from the Heart Failur[J]. European Journal of Heart Failure, 2010, 12(8):767–778.
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围产期心肌病定义 Peripartum Cardiomyopthy, PPCM
围产期心肌病:以急性心力衰竭起病或出现扩张型心肌病样改变,发病时间局限在妊娠最后3个月或产后5个月内,既往无心血管系统疾病史,这种特殊的心脏疾病称之为PPCM——中华妇产科学
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Definition and Pathophysiology
‘Peripartum cardiomyopathy is an idiopathic cardiomyopathy presenting with HF secondary to left ventricular (LV) systolic dysfunction towards the end of pregnancy or in the months following delivery, where no other cause of HF is found. It is a diagnosis of exclusion. The LV may not be dilated but the ejection fraction (EF) is nearly always reduced below 45%’.
Contributing factors:
General risk factors for cardiovascular disease (such as hypertension, diabetes, and smoking)
Pregnancy-related factors (such as age, number of pregnancies, number of children born, use of medication facilitating birth, and malnutrition).
Prolactin, 16 kDa prolactin, and cathepsin D
Other putative pathophysiological mechanisms
Inflammation
Serum markers of inflammation [including the soluble death receptor sFas/Apo-1, C-reactive protein, interferon gamma (IFN-g), and IL-6] are elevated in patients with PPCM.
Viruses
Although some reports have implicated cardiotropic enteroviruses in PPCM, others have not found a higher frequency of viral infections in patients with PPCM than in those with IDCM.
Autoimmune system
Serum derived from PPCM patients affects in vitro maturation of dendritic cells.
ic susceptibility to peripartum cardiomyopathy
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Clinical presentation and diagnosis
Early signs and symptoms
Pedal oedema, dyspnoea on exertion, orthopnoea, paroxysmal nocturnal dyspnoea, and persistent cough.
Additional sy