(精选)【高血压英文课件精品课件】Hypertensive disease in pregnancy教学课件.pptVIP

/wayneheim/vegf.jpg VEGF– vascular endothelial growth factor. Is it good, or bad? Both, of course. Helps to build new blood vessels and breaks down basement membrane in the process. /invest/annual99/prod_vegf2.htm What do we observe in pre-E? Evidence of vasoconstriction Increased wave reflection from muscular arteries (augmentation index). Increased SVR of arterioles, reflex decreased CO Increased cardiac natriuretic peptides (heart tries to compensate for increased wall stretch (afterload). Wave reflection comes from muscular arteries (larger than arterioles) Ayten Elvan-Tas? pinar, Arie Franx, Michiel L. Bots, Hein W. Bruinse, and Hein A. KoomansAm J Hypertens 2004;17:941–946 Visual example of increased augmentation index in pre-eclampsia. Normotensive 29 yo pregnant woman Pre-eclamptic patient, 29 yo. Mats Ro¨ nnback, M.D.,1, 2,* Katja Lampinen,2,3 Per-Henrik Groop,1,2 and Risto Kaaja3 Hypertension in Pregnancy, 24:171–180, 2005 Pre-eclampsia is associated with an increase in augmentation index. Most SVR is provided by the arterioles (0.1-0.4 mm) /Characteristics+of... Cite this article as: Tihtonen KM, K??bi T, Vuolteenaho O, et al. Natriuretic peptides and hemodynamics in preeclampsia. Am J Obstet Gynecol 2007;196:328.e1-328.e7. In pre-eclampsia, we see increased SVR (arteriolar constriction), MAP and decreased CO. Atria and ventricles respond by increasing natriuretic peptide secretion. 10 0 3000 2000 1000 0 Nominal cardiac output L/min Nominal systemic vascular resistance dyn.sec.cm-5 Blood pressure mm Hg Heart rate beats/min and nominal stroke volume mL 300 200 100 0 150 100 50 0 FIGURE 3 etomidate induction in preE and lupus 0 A B 5 10 15 C D 20 SV minutes Nicardipine lowers SVR and increases CO in patient