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CHANGES IN CARDIAC FUNCTION

CHANGES IN CARDIAC FUNCTION BECOMES APPARENT DURING FIRST 8 WKS OF PREGNANCY CARDIAC OUTPUT INCREASES AS EARLY AS 5TH WEEK OF PREG BETWE 10 TO 12 WKS PLASMA VOLUME EXPANSION BEGINS, AND PRELOAD INCREASES HEART AS THE DIAP D

HEART

AS THE DIAPHGRAM GETS ELEVATED HEART IS DISPLACED TO LEFT UPWARD AND IS ROATED ON ITS OWN AXIS APEX IS MOVED LATERALLY SOME DEGREE OF BENIGN PERICARDIAL EFFUSION IS PRESENLARGER CARDIAC SILHOUTTE ON CHEST RADIOGRAPH ON ECG THERE IS SLIGHT LEFT AXIS DEVIATION ,CARDIAC SOUNDS ----------------------------EXAGGERATED SPLITTING OF FIRST HEART SOUNDS WITH LOUDNESS OF BOTH COMPONENTS NO CHANGE IN 2ND HEART SOUND A LOUD THIRD HEART SOUND SYSTOLIC MURMER IN 90 % OF WOMAN WHICH INTENSIFIED DURING INSPIRATION,DISSAPEARS SHORTELY AFTER DELIVERY A SOFT DIASTOLIC MURMER IN 20 % CONTINOUS MURMER IN ARISING FROM BREAST VASCULATURE IN 10% INCREASED VENTRICULAR MUSCLE MASS INDEX DOES NOT CORROSPONDS TO HYPERTROPHY

K TOCA
CARDIAC OUTPUT AT REST INCREASES WHEN MEASURED IN LATERAL RECUMBENT POSITION , BEGINNING IN EARLY PREGNANCY CARDIAC OUTPUT IS INCREASED BY 20 % AT TERM WHEN A WOMAN IS MOVED FROM HER BACK TO LEFT SIDE FETAL OXYGEN SATURATION IS 10% HIGHER WHEN A LABOURING WOMAN IS IN LEFT LAT POSITION IN MULTIFETAL PREG CO IS INCREASED BY 20% BUT THE CARDIOVASCULAR RESERVE IS REDUCED

ARTERIAL PRESSURE USUALLY DECREASES TO A NADIR BY 24 T 26WKS AND RISES THEREAFTER, DIASTOLIC PRESSURE DECREASES MORE THAN SYSTOLIC BRACHIAL ARTERY PRESSURE IS MORE IN LLP THAN SITTING ANTECUBITAL VENOUS PRESSURE REMAINS UNCHANGED BUT FEMORAL SSURE RISES STEADELY THERE IS TENDENCY TOWARDS STAGNATION OF BLOOD FLOW IN LOWER EXTRE DUR LATERNG LATER HALF OF PREGNANCY WHICH IS DUE TO OCCLUSION OF PELVIC VEINS AND IVC BY ENLARGED UT,THIS LEADS TO ELEVATED VENOUS PRESSURE.WHICH NORMALIZES WHEN A WOMAN LIES ON HER SIDE.THIS EXPLAINS DDEPENDANT EDEMA DEVELOPMENT OF VARICOSE VEINS IN LEGS VULVA AND HAEMORROIDS,PREDISPOSES TO DVT

CIRCULATION AND BP,

SUPINE HYPOTENSION SYNDROME


SEEN IN 10% WOMAN SUPINE COMPRESSION OF GREAT VESSELS BY UT CAUSES SIGNIFICANT ARTERIAL HYPOTENSION IN SUPINE POSITION UT ARTERY PRESSURE IS LOWER THAN IN BRACHIAL ART THIS MAY AFFECT FHR PATTERN

RENIN .ANGIOTENSIN II,AND PLASMA VOLUME