As a cardiologist, I see a lot of referrals for patients who are pregnant with symptoms that indicate potential heart problems in pregnancy. Thankfully the vast majority have a perfectly healthy and normal heart. The latest national report into maternal deaths (https://www.npeu.ox.ac.uk/mbrrace-uk/reports) highlights some important things to consider for women who are pregnant and who might potentially have heart problems. Being pregnant carries its own difficulties – the development of additional heart problems can be cause for concern and requires specialist monitoring with collaboration between cardiologists, obstetricians and midwives.
Thankfully heart problems during pregnancy are rare – affecting 2 in every 100,000 pregnancies. Women who are known to have heart disease are considered to be at high risk and require specialist care. For any pregnant woman who is concerned they have heart problems it is important to be vigilant for certain symptoms. Breathlessness is common in pregnancy but if breathlessness seems out of proportion, such as walking just a few feet, and particularly if lying flat then it is important to seek help. Other symptoms that might indicate a potential heart problem are severe chest pain (especially if it goes into the back) palpitations (a rapid heart beat), dizziness or light-headedness or excessive swelling of the ankles. Hypertension in pregnancy is also an important condition but this definitely requires specialist obstetric and midwife care particularly because regular monitoring of the baby, as well as careful control of the blood pressure, is required. The first port of call for any pregnant woman should always be their local maternity unit. However, once they have seen their midwife or obstetrician and they have recommended a cardiologist’s opinion it is important to see one as soon as possible.
What tests would a pregnant patient expect to have once she has seen a cardiologist? A 12 lead ECG is a very simple but practical bedside test that often provides immediate reassurance that nothing serious is happening. Further tests are an echocardiogram (heart ultrasound scan) particularly for breathless patients and portable ECG monitoring to investigate palpitations. All of these tests are perfectly safe to do in pregnancy and will help rule out any serious heart problems. The key thing to remember is these tests need to be done urgently, certainly within a few weeks of first developing symptoms.
Heart rhythm problems (arrhythmia) can sometimes become worse during pregnancy. Pregnant women can experience more ectopic heartbeats (extra beats) as well as more significant arrhythmias such as supraventricular tachycardia. Atrial fibrillation is rare in pregnancy. Whilst under normal circumstances drugs can be used to treat these heart rhythm problems it is recommended to avoid medications during pregnancy if at all possible, particularly in the first trimester of pregnancy when fetal development is at it’s earliest stage and they are vulnerable to the effects of drugs. If drug treatment for arrhythmia is required then beta-blockers are considered to be safe during pregnancy.
Heart failure is a recognised but potentially serious complication that can develop in pregnancy. The medical term for this is peri-partum cardiomyopathy and can cause symptoms such as severe breathlessness, especially when lying flat and sometimes swelling of the ankles and legs. It is diagnosed with an echocardiogram (heart ultrasound) and when it is diagnosed requires very close monitoring as well as immediate treatment. It causes the heart to enlarge and the heart muscle weakens. It is more common if the patient is overweight, smokes or has a history of heart problems. It occurs most commonly in the last month of pregnancy but also up to 5 months following birth. Patients who have developed peri-partum cardiomyopathy during or after their pregnancy are at higher risk of developing the condition in future pregnancies.
Thankfully the condition is treatable and patients survive the condition often making a complete recovery. I have included a case study of one such survivor who tells her story of developing and eventually recovering from per-partum cardiomyopathy: http://heartinsight.heart.org/Fall-2015/A-Rough-Pregnancy/.
If you are pregnant and are having any of the symptoms discussed above the first point of contact is your midwife or obstetrician. If they recommend you seeing a cardiologist for further tests you can make an appointment to see Dr. Hamaad by calling 0121 396 1216 or filling out an enquiry form.
