Hosokawa Ami, Umazume Takeshi, Yamada Takahiro, Minakami Hisanori
Graduate School of Medicine, Hokkaido University, Sapporo, Japan.
BMJ Case Rep. 2017 May 13;2017:bcr-2016-217964. doi: 10.1136/bcr-2016-217964.
A 36-year-old nulliparous woman developed pre-eclampsia at gestational week (GW) 28 Cardiac status was checked regularly. Heart rate of 93 beats per minute (bpm) with left atrial diameter (LAD) of 35 mm, left ventricular hypertrophy and inferior vena cava diameter (IVCD) of 8 mm at GW 32 decreased to 48 bpm with an expanded IVCD to 25 mm, dilated left atrium (LAD to 39 mm), increased pulmonary arterial pressure, increased systemic vascular resistance (approximate 3000 dyn s/cm) and biphasic intrarenal venous flow pattern 3.5 hours prior to childbirth at GW 32 Epigastralgia, tachycardia (160 bpm) and marked hypertension (201/111 mm Hg) occurring 2 hours after echocardiography necessitated caesarean section, with subsequent development of HELLP syndrome. Acute fluid shift from the splanchnic vasculature to central vasculature may have occurred causing HELLP syndrome as a result from vasospasm associated with sympathetic hyperactivity. The cause of bradycardia prior to tachycardia remains unclear.
一名36岁未生育女性在孕28周时发生子痫前期，定期检查心脏状况。孕32周时心率为93次/分钟，左心房直径（LAD）为35mm，左心室肥厚，下腔静脉直径（IVCD）为8mm；到分娩前3.5小时，心率降至48次/分钟，IVCD扩大至25mm，左心房扩张（LAD至39mm），肺动脉压升高，全身血管阻力增加（约3000达因秒/厘米），肾内静脉血流呈双相模式。超声心动图检查2小时后出现上腹部疼痛、心动过速（160次/分钟）和明显高血压（201/111mmHg），需行剖宫产，随后发展为HELLP综合征。可能发生了从内脏血管系统到中心血管系统的急性液体转移，导致与交感神经过度活跃相关的血管痉挛而引发HELLP综合征。心动过速之前心动过缓的原因尚不清楚。
