Echo Doppler Assessment of Autonomic Dysfunctions in Second Trimester of Pregnancy
Echo Doppler AssessmEcho Doppler Assessment of Autonomic Dysfunctions in Second Trimester of Pregnancyent of Autonomic Dysfunctions in Second Trimester of Pregnancy
Keywords:
Autonomic Function, echo Doppler, pregnencyAbstract
For the present study subjects were randomly selected from the females in the age group of 20 – 30 years with the singleton mid-term pregnancy (20 -28 weeks) attending antenatal clinics of New Civil Hospital, Surat. The control group comprised of purposive sample (33 healthy subjects) selected from those attending other outpatient department in reference to comparable age, height & accessibility. The subjects were asked to perform valsalva manoeuvre by forcibly exhaling in an aneroid pressure measuring device (manometer) & maintain a pressure of 40 mmHg for 15 seconds or less formally the patient may be asked to bear down as if having a bowel movement. It is used as a diagnostic tool to evaluate the condition of the heart. Echocardiography was recorded using MEGAS CVX & MEGAS GPX equipped with ADV4 software from ESAOTE s.p.a Firenze, Italy. For Doppler echocardiography the frequency used was 2.0 -2.5 – 3.3 -5.0 MHZ & sweep time was 2 – 12 seconds. Our observations suggests that volume overload during pregnancy is a risk factor for left ventricular contractility functions. Increased values of stroke volume, cardiac output & cardiac index interpret the result of inability to compensate pressure overload or elevated venous return. Left ventricular diastolic dysfunction in the form of relaxation abnormalities is one of the first changes with left ventricular hypertrophy. In our study sample the pregnant females after performing valsalva manoeuvre decreased mean E/A ratio was observed compared to the non pregnant females. It has been suggested that changes in the left atrial pressure may mask or mimic left ventricular diastolic function abnormalities detected by Doppler echocardiography. The valsalva manoeuvre could help better to account for the effect of left atrial pressure on the transmitral flow velocity profile & differentiate between subjects with or without LV diastolic function abnormalities
References
Mecacci F, Parretti E, Martinni E,
Vecchiarino S, Franchi F and La Villa G.
Cardiovascular functions in pregnancy &
effect of posture. BJOG 2001 April, 108
(4): 344 – 52
2. Souma ML, Cabaniss CD, Natraj A, Khan
Z. The valsalva maneuver: a test of
autonomic nerve system function in
pregnancy. Am J Obstet Gynecol. 1983 Feb
1; 145,30: 274 -8.
3. Ekholm Em, Piha SJ, Erkkola RU & Antila
KJ. Autonomic cardiovascular reflexes in
pregnancy. A longitudinal study. Clin
Auton Res. 1994 Aug; 4(4): 161-5
4. Rostango C, Felici M, Caciolli S, Olivo
G,Comeglio M, Galanti G, Serneri GG.
Istituto di Clinica Medica e Cardiologia,
Universita di Firenze, Italy. Decreased
baroreceptor sensitivity assessed from
phase IV of valsalva menoeuver in mild
congestive heart failure. Angilogy 1999
Aug; 50(8): 655-64.
5. Rostango C, Galanti G, Felici
M,Meccherinin M,Sani G, Caciolli S,
Gensini GF. Istituto di Clinica Medica e
Cardiologia, Universita di Firenze, Italy.
Prognostic value of baroreceptor sensitivity
assessed by phase IV of valsalva
menoeuver in patients with mild to
moderate heart failure. Eur J heart Fail.
2000 Mar; 2(1): 41 -5.
6. Sander K, Hansen J, sander M, et al.
Sympathetic overactivity in pregnancy
induced hypertension. Circulation. 1995;
92: 42 – 1.
7. Dumesnil JG, Gaudreault G, Honos GN,
Kingma JG Jr. Quebec Heart Institute,
Leval University, Sainte-Foy, Canada. Use
of Valsalva maneuver to unmask left
ventricular diastolic function abnormalities
by Doppler Echocardiography. Am J
cardiology 1991 Aug 15; 68(5) : 515 – 9
8. Echocardiographic assessment of
cardiovascular hemodynamics in normal
pregnancy. Obstetrics & Gynecology 2004;
104: 20 -29
9. Galderisi M, Dini FL, Temporelli PL,
Colonna P, de SSimone G. Doppler
echocardiography for assessment of left
ventricular diastolic function: methodology,
clinical & prognostic value. Ital Heart J
suppl. 2004 Feb; 5(2): 86 – 97.
10. Rang S, Wolf H, Montfrans GA,
Karemarker JM. Noninvasive assessment of
left ventricular end diasolic pressure by the
response of the transmitral – a – wave
velocity to a standardized valsalva
maneuver. Am J Cardiol. 2002 Jul 15; 86
(2) : 169 -74
