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Pregnancy and heart disease

Pregnancy and heart disease

Pregnancy and heart disease is a complicated subject that needs to be elaborated. Heart disease during pregnancy affects other body parts like the respiratory system. Knowing that you have an underlying heart disease could make you hesitate to conceive even when you have the will. Hang on and keep reading to get life-saving tips.

Pregnancy and heart disease

Are you worried about pregnancy and heart disease? Many people have similar concerns—and you are one step from learning all about the condition. Read on to understand the causes, symptoms, diagnosis, and management of heart problems during pregnancy.

Causes of heart disease during pregnancy

Heart disease in pregnancy is mainly caused by conditions that the woman may already be having. The pre-existing conditions may then progress and lead to heart disease. Some of the pre-existing conditions include;

  • Hypertension
  • Diabetes mellitus
  • Congenital heart disease
  • Preeclampsia in a previous pregnancy

Other causes of heart disease during pregnancy are adjustable. It means treating them by taking medications or changing their lifestyle is the correct choice. They include:

  • High blood pressure
  • Alcohol/drug abuse during pregnancy
  • Obesity
  • Poor nutrition

Symptoms of heart disease during pregnancy

Symptoms that suggest the presence of heart issues while pregnant include:

  • Fatigue
  • Fainting and lightheadedness
  • Shortness of breath
  • Swelling of feet, ankles, and arms
  • Chest pains
  • Discomfort when breathing while lying down flat
  • Tachycardia, tachypnea
  • Jugular vein distention

Some of these symptoms are still present even in normal pregnancies. It is important to take a thorough history to tell the difference between the two.

Diagnosis of heart disease during pregnancy

Heart disease in pregnancycan be identified by doing laboratory work and diagnostic tests. They help in giving clues about underlying conditions. Increased white blood cells show inflammatory heart conditions like myocardial infarction.

Regular heart changes during pregnancy cause the heart to rotate to the left. There is also a mild left-axis deviation. Do an electrocardiogram to show this finding. An echocardiogram displays chamber enlargement, physiological aortic, mitral, tricuspid regurgitation, and vulvar dilation.

Management

No suggested medication can prevent cardiac diseases during pregnancy. Instead, those who have underlying cardiac conditions should increase vigilance when pregnant. Additionally, these individuals should continue taking their prescribed pills without failure. But if their medications contain properties that would raise birth defects in a baby, they should consult a doctor who can substitute them.

Risk stratification and counseling

Women with heart issues while pregnant should receive counseling from a multi-disciplinary team of heart and maternal specialists. The team should be able to provide a comprehensive review of heart risk, obstetric risk, fetal risk, and possible outcomes. The World Health Organisation came up with a risk estimation model that shows factors known to increase maternal heart risk. The risks include

  •  Prior heart failure
  •  Prior cardiovascular disease
  •  History of arrhythmia
  •  Resting cyanosis
  •  Use of anticoagulant therapy
  •  The presence of a mechanical valve

Also in the risk estimation model, there are several conditions felt to be of very high risk for a woman to continue with a pregnancy. The conditions include

  • Pulmonary arterial hypertension,
  • Severe ventricular dysfunction,
  • Severe left-sided heart obstruction,
  • Significant aortic dilatation with underlying connective tissue disease

Women with these underlying conditions are often advised to avoid getting pregnant. Even so, if a woman has these conditions and becomes pregnant, cardio-obstetric specialists must come up with solutions to lessen the cardiovascular risk, obstetric risk, and fetal risk.

Antepartum management

Antepartum care is also referred to as prenatal care. It comprises all the necessary management measures taken during the pregnancy period. Antepartum care helps in recognizing potential risks to the mother and fetus. This healthcare method has separated pregnancy into three stages;

  • 1st trimester (0–14 weeks)
  • 2nd trimester (15–28 weeks)
  • 3rd trimester (29–42 weeks)

During the 1st trimester, transvaginal sonography identifies and confirms the location of the pregnancy. Do laboratory tests in this first trimester to show a complete blood count and blood type. It is in this lab test that the critical RH factor test is done.

In the 2nd trimester, an updated history of the mother and fetus is taken. It is in this trimester that the mother starts feeling the movement of the fetus. Gestational diabetic screening is also done during this trimester. For the negative RH patients, administer the rhogam dose at 28 weeks.

The 3rd-trimester care includes final preparations, screenings, necessary treatments, and counseling to ensure safe delivery.  The size of the baby and position might make you uncomfortable during this period. In the late third trimester, patients have to go for weekly reviews to check

  • early labor signs
  • fetal distress
  • Associated maternal complaints

Patient education

Cardiovascular disease has been a prevalent cause of complications during pregnancy. Congenital heart disease—cardiovascular disease is the leading cause affecting pregnancies. Besides, cardiomyopathy causes the most severe complications in pregnancy.

During pregnancy, heart rhythm issues are common. They usually do not pose a significant risk. Treatment is the same as that provided even when not pregnant.

Pathophysiology

Preeclampsia is a condition that occurs explicitly during pregnancy. It results in the narrowing of large blood vessels on the heart’s surface. This usually occurs after the 20th week of pregnancy. It can even prolong to the 4–6th week after delivery.

The prevailing characteristic of this condition is a sudden rise in blood pressure. The systolic blood pressure is usually higher than 160 mmHg. Also, diastolic blood pressure is higher than 110 mmHg. Through a laboratory test, a high protein level in urine—proteinuria is also recognized.

Physiological changes during pregnancy and puerperium

During pregnancy, almost every body part goes through significant changes. There are structural changes to the left ventricle and also hormonal fluctuations. The changes lead to a 40% to 45% increase in blood volume and bodily fluids. Also, it is normal to have an increased heart rate during pregnancy.

The heart rate increases by 10 to 20 beats per minute, thus; the pulse is high during pregnancy. Cardiac output—the amount of blood pumped by the heart per minute, increases by 30% to 50% because of the higher blood volume and increased heart rate. If pregnant with twins, cardiac output could rise to 60%. Most of the pregnancy and delivery changes resolve 6 weeks after delivering, and the body returns to its normal state.

Pregnancy causes an increase in iron requirements. This iron is used in the production of hemoglobin that transports the much-needed oxygen molecules, not only to the mother but also to the fetus. That is why most pregnant women crave iron-rich foods. Besides that, platelet count tends to drop but remains within normal ranges.

Evaluation/ prognosis

The World Health Organisation produced a modified list of maternal cardiovascular risk classifications. It is used to check the risk status of pregnant women with cardiovascular diseases. The list is as follows:

  • I: No Identifiable elevated risk of maternal morbidity.
  • II: Mildly elevated risk of maternal morbidity.
  • III: Substantially elevated risk of maternal morbidity.
  • IV: Extremely elevated risk of maternal morbidity.

Complications

Pregnancy may lead to many complications. Heart problems may develop even without a prior history of the condition. Some of the complications include

  • Hemorrhage or bleeding
  • Progressive heart failure
  • Preeclampsia
  • Placenta previa
  • Placenta abruption
  • Preterm birth
  • Gestational diabetes
  • Excessive weight gain
  • Fetal death

Fast facts about pregnancy and heart disease

Cardiovascular heart disease stands as the leading cause of complications in pregnancy. If you have an underlying heart problem and are planning on getting pregnant, visit a cardio-obstetric specialist first. Because of the underlying heart disease, you could experience heart rhythm changes and heart murmur during pregnancy.

If the heart disease is not taken care of, one could get heart failure in pregnancy. Together with that, does your heart beat faster when pregnant? Do not worry much about it; pregnancy causes an increase in blood volume, and thus the heart rate has to increase.

How does heart disease affect pregnancy?

There are certain heart conditions — like the narrowing down of the mitral valve and aortic valve, that pose life-threatening risks. Other conditions expose a woman to a fatal threat, and so they are limited to getting pregnant. One of the rare congenital conditions is high blood pressure that affects the arteries in the lungs and the right side of the heart—Eisenmenger’s syndrome.

What is the common heart disease in pregnancy?

Cardiovascular disease (CVD) has been the most common in women of childbearing age. 4% of pregnant women may develop heart complications despite not having an underlying condition. Up to 26.5% of pregnancy-related deaths can be traced back to cardiovascular heart disease.

Can pregnancy weaken your heart?

Pregnancy adds pressure on your heart and blood vessels. Blood increases by 40% to 50% to nourish the baby’s growth, so the heart rate has to go up every minute. Changes in blood flow and pressure during labor mean there is an extra workload for the heart. It takes up to 6 weeks after delivery for the heart to return to its normal functioning.

To sum up, clarity about pregnancy and heart disease is an add for you to make a good plan for your reproductive health. You can now even impart the same knowledge to those surrounding you. Take care of the pregnant with confidence.

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