Are you aware of Cardiac Disease in Pregnancy? Let's talk!

If you are a mother-to-be or are already pregnant, this article will be very important for you. Pregnancy is a very special, beautiful time, and a time when our bodies undergo a lot of changes. Our heart, in particular, has an extra workload during this time, because the heart has a big role in providing the necessary nutrition and oxygen to both the mother and the baby. So, today we will talk about the possibility of heart disease during this time and how pregnancy affects those who already have heart disease.

What heart diseases can occur during pregnancy?

Simply put, this is what is called problems with your heart during pregnancy. There are two main types:

1. Preexisting heart conditions: These are heart conditions that you had before you became pregnant. These may not have caused you any major symptoms or been a major problem. However, during pregnancy, these conditions can affect you differently and can cause various complications.

2. Heart conditions that develop during pregnancy: These are conditions that you didn't have before you got pregnant and that develop during pregnancy. Some of them may be harmless, but some can be dangerous.

Most women with heart disease can safely get pregnant and give birth to a healthy baby. However, sometimes heart disease during pregnancy can lead to serious complications. In fact, heart disease has been identified as the leading cause of maternal deaths in some developed countries.

• According to some reports, about a third of pregnancy-related deaths are due to problems with the cardiovascular system.
• About 4 out of 100 pregnant mothers may develop complications due to cardiovascular disease.
• Factors such as high blood pressure, obesity, and age over 40 are factors that increase the risk of death during pregnancy.

If you're pregnant or planning to become pregnant, it's important to know how heart disease can affect you. But before that, let's take a look at how pregnancy affects your heart and blood vessels.

Changes in your heart and blood vessels during pregnancy

Your body goes through a lot of changes during pregnancy. These changes put extra strain on your body, and your heart has to work harder. The changes below are normal during pregnancy. They help your growing baby get the oxygen and nutrients it needs.

• Increased blood volume: Your blood volume starts to increase in the first few weeks of pregnancy, and it continues to increase. Most women's blood volume increases by 40% to 45% during pregnancy. Just think, how much more blood your heart has to pump than it normally does!
• Increased heart rate: It is normal for your heart rate to increase by about 10 to 20 beats per minute during pregnancy. This increases gradually, reaching its peak during the third trimester.
• Increase in cardiac output: Cardiac output is the amount of blood your heart pumps per minute. Between weeks 28 and 34, your cardiac output can increase by 30% to 50%. This is due to an increase in blood volume and an increase in heart rate. If you are carrying twins, your cardiac output can increase by up to 60%.

These changes may make you feel things like:

• Feeling very tired (fatigue) .
• Feeling dizzy.
• Difficulty breathing (dyspnea) .
• Feeling like your heart is beating fast (palpitations) .

These are common symptoms of pregnancy. But here's the problem: These same symptoms can also be symptoms of some heart conditions. So, even if you have warning signs of heart disease, you might ignore them, thinking, "This is just how it is during pregnancy." That's why heart disease during pregnancy can be dangerous. It can be hard to know if a symptom is normal or something to worry about.

If you have pre-existing heart disease, you are at higher risk of developing heart-related complications during pregnancy. Your risk depends on the specific condition you have and its severity.

What pre-existing heart conditions can affect pregnancy?

Some heart conditions can increase your risk of complications during pregnancy. If you have any of the conditions below, talk to your doctor about the risks of pregnancy.

Congenital heart disease

Congenital heart disease is a condition that is present at birth. Some of these conditions can be minor, while others can be very serious. Babies with serious conditions are usually treated at a young age. However, sometimes changes in heart function can occur after treatment or surgery.

So, if you have a congenital heart disease, it's important to talk to your doctor before you get pregnant. Your doctor may refer you to an adult congenital heart disease specialist or a cardio-obstetrics specialist. They can assess your pregnancy risks. They can also help you identify and manage the risks of an unplanned pregnancy.

The most common heart complications seen in pregnant women with congenital heart disease are:

• Heartbeat abnormalities (arrhythmia) .
• Heart failure .

If you have a congenital heart disease, you are also at higher risk of premature birth .

In general, women with the following congenital heart conditions are at lower risk of problems during pregnancy:

• Mild pulmonary valve stenosis.
• If small "holes" in the heart have been successfully repaired, such as atrial septal defects (ASDs) and ventricular septal defects (VSDs).
• Small or successfully repaired patent ductus arteriosus (PDA).

Women with these congenital heart conditions may be at increased risk of pregnancy complications:

• Aortic valve stenosis with a bicuspid aortic valve.
• Coarctation of the aorta.
• Ebstein's anomaly.
• Fontan physiology.
• Severe pulmonary valve stenosis.
• Tetralogy of Fallot (repaired)
• Transposition of the great arteries (repaired)

Remember, there are many other congenital heart defects that are not on this list. Even if your heart condition is not on this list, it is still important to talk to a doctor if you are thinking about getting pregnant.

Cardiomyopathy

Cardiomyopathy is a leading cause of serious complications and death during pregnancy. Your risk of complications from cardiomyopathy depends on the type you have and its severity.

About 4 out of 10 women with dilated cardiomyopathy will develop a heart attack or other complications. Hypertrophic cardiomyopathy is less dangerous during pregnancy. However, it can still cause complications, especially if you had symptoms before you got pregnant.

If you have any type of cardiomyopathy, talk to your doctor about your risks before getting pregnant.

Heart valve disease

There are many types of heart valve disease that can occur during your lifetime. They can range from mild to severe. Some valve diseases may not affect your pregnancy, but others can increase your risk of complications. If you have a history of valve disease, talk to your healthcare provider to find out if pregnancy is safe for you.

• Aortic valve regurgitation: Your risk level depends on the severity of the regurgitation (leakage). If you have no symptoms and your heart is working normally, you are at low risk of complications. However, if you have severe regurgitation with reduced heart function, you are at higher risk and may need to avoid pregnancy. Associated conditions such as Marfan syndrome or a bicuspid aortic valve can also affect your risk.
• Mitral valve prolapse: This is a common condition that usually causes no symptoms or requires treatment. Most women with mitral valve prolapse who do not have other heart problems do not have any pregnancy complications. If your condition has caused severe leakage of the valve, you may need to be treated before you become pregnant.
• Mitral valve regurgitation: Your risk level depends on how leaky your valve is, how well your heart can pump blood, and whether you have symptoms. If your regurgitation is severe and you have symptoms, you may need to have a mitral valve repair before getting pregnant. Women with severe regurgitation and poor heart function may also need to avoid getting pregnant.
• Mitral valve stenosis: This is the most common heart complication during pregnancy worldwide. It is more common in areas where rheumatic fever (a condition caused by untreated scarlet fever and throat infections) is common. If you have mitral valve stenosis, you may need to have a procedure or surgery before you get pregnant to reduce your risk of complications.

Valve replacement can help people with valve disease live long, healthy lives. But women with prosthetic heart valves need special care during pregnancy. Because:

• Pregnancy increases your risk of blood clots. Having an artificial valve also increases your risk of blood clots.
• If you have some prosthetic valves, you will need to take anticoagulant medication for the rest of your life to reduce the risk of blood clots. Some anticoagulants can be harmful to the baby.

If you have a prosthetic valve, it is very important to see a cardiologist before planning a pregnancy. Your cardiologist will talk to you about:

• Your pregnancy risks.
• The treatment that prevents blood clots that is right for you.
• Precautions you should take to prevent endocarditis.

Aortic disease

Aortic disease, or aortopathy, is a group of diseases that affect your aorta. Genetic syndromes are associated with some aortic diseases.

Aortic disease increases the risk of serious complications during pregnancy. This is because the pressure on the aorta increases during pregnancy, especially during labor and delivery. This extra pressure increases the risk of aortic dissection or aneurysm rupture, which can be fatal.

Women with the following conditions are at higher risk of complications during pregnancy:

• Bicuspid aortic valve with aortic dilation.
• Having a history of aortic dissection.
• Loeys-Dietz syndrome.
• Marfan syndrome.
• Turner syndrome.
• Vascular Ehlers-Danlos syndrome.

Important: About half of aortic dissections and ruptures in women under the age of 40 are pregnancy-related. They usually occur in the third trimester or after childbirth.

If you have aortic disease, it is very important to see a cardiologist for an evaluation before planning a pregnancy.

What new heart problems can occur during pregnancy?

Even if you have no prior history of cardiovascular disease, pregnancy can cause various problems with your heart or blood vessels.

High blood pressure (Hypertension)

High blood pressure during pregnancy affects about 1 in 10 pregnant women. It is also a common condition.

High blood pressure diagnoses include:

• Gestational hypertension: High blood pressure (at least 140/90 mmHG) that begins after 20 weeks of pregnancy.
• Preeclampsia: High blood pressure that begins after 20 weeks. This is accompanied by protein in your urine or evidence of organ damage. Eclampsia is a condition that occurs during pregnancy or within 10 days of delivery, accompanied by seizures.
• Chronic hypertension: High blood pressure that starts before 20 weeks or before you become pregnant.
• Chronic hypertension with superimposed preeclampsia: Chronic hypertension with protein in the urine or evidence of organ damage.

Gestational diabetes

Gestational diabetes is high blood sugar levels that develop after 20 weeks of pregnancy. If left untreated, this condition increases the risk of complications for you and your baby.

Heartbeat irregularities (Arrhythmias)

Pregnancy increases your risk of developing an irregular heartbeat (arrhythmia), whether you have had it before or not. Types of arrhythmias you may experience during pregnancy include:

• Ectopic heartbeat: This is an extra heartbeat that is usually harmless.
• Supraventricular tachycardia (SVT): This is a rapid heartbeat that starts in the upper chambers of your heart (atria). This is the most common long-lasting arrhythmia (lasting more than 30 seconds) seen during pregnancy. You are at higher risk if you have a history of SVT or a congenital heart defect. But it can also happen for the first time during pregnancy.

Some arrhythmias require treatment, and some do not. Women with congenital heart disease and arrhythmias are more likely to need treatment. Your healthcare provider will determine the safest treatment for you.

Spontaneous coronary artery dissection (SCAD)

Spontaneous coronary artery dissection (SCAD) is a life-threatening condition. SCAD is a tear in one or more of the arteries that supply blood to your heart. 4 out of 5 people who experience SCAD are women. About 1 in 3 cases are related to pregnancy. SCAD usually occurs within a week of giving birth, but can also occur late in pregnancy or within six weeks of giving birth.

Researchers believe that hormonal changes during pregnancy play a role. Other risk factors among pregnant women include:

• Over 30 years of age.
• Cocaine use.
• Connective tissue diseases.
• Diabetes.
• High blood pressure.
• Tobacco use.

Decreased blood supply to the heart muscle (Myocardial ischemia)

Myocardial ischemia is when your heart doesn't get enough blood. This can cause:

• Stable angina.
• Unstable angina.
• Heart attack.

About 2 in 25,000 pregnancy-related hospitalizations are due to myocardial ischemia. Risk factors for pregnant women include:

• Over 30 years of age.
• Diabetes.
• Family history of cardiovascular disease.
• High blood pressure.
• High cholesterol or high triglycerides.
• History of spontaneous coronary artery dissection `(SCAD)`.
• Overweight/obesity.
• Tobacco use.

Peripartum cardiomyopathy

Peripartum cardiomyopathy is a type of heart failure that occurs in late pregnancy or shortly after giving birth. It affects women who have not previously been diagnosed with heart disease. This condition makes your heart unable to pump enough blood to your body. It can happen at any age, but it usually affects people over the age of 30.

Deep vein thrombosis and pulmonary embolism

Pregnancy increases the risk of deep vein thrombosis (DVT) and pulmonary embolisms (PE). These conditions are four to five times more common in pregnant women than in non-pregnant women. They usually occur in the postpartum period (within six months of giving birth).

A deep vein thrombosis (DVT) is a blood clot in a deep vein in your body (usually in your leg). A pulmonary embolism (PE) is a blood clot that forms somewhere in your body and travels to your lungs.

Your risk is higher if you have a history of blood clots or embolism. If you have a DVT or PE, you will likely need to be treated with blood thinners. Your doctor should prescribe a blood thinner that is safe during pregnancy.

What is the most common heart disease during pregnancy?

Congenital heart disease is the most common type of heart disease in developed countries.

In developing countries, rheumatic heart disease is the most common type of heart disease, accounting for about 7 out of 10 cardiovascular events during pregnancy.

What heart conditions are very dangerous for pregnancy?

Some heart conditions and related syndromes make pregnancy very dangerous. You may need to avoid getting pregnant if you have these conditions:

• Aortic valve stenosis (if severe and causing symptoms)
• Coarctation of the aorta (if uncorrected or existing along with an aortic aneurysm)
• Eisenmenger syndrome.
• Fontan physiology.
• Marfan syndrome.
• Mitral valve stenosis (if severe)
• Peripartum cardiomyopathy in a previous pregnancy (with remaining damage to heart function)
• Pulmonary hypertension.
• Severe aortic dilation (at least 45 mm if you have Marfan syndrome, at least 50 mm if you have a bicuspid aortic valve)
• Ventricular dysfunction with left ventricular ejection fraction less than 40%

If you have any of these conditions, talk to your doctor. He or she will assess the severity of your condition and discuss your risks with you.

What are the signs and symptoms of heart problems during pregnancy?

Some symptoms of heart problems are similar to what you might normally experience during pregnancy. These include:

• Feeling very tired (fatigue) .
• Frequent need to urinate.
• Difficulty breathing.
• Swelling of the feet and ankles (edema) .

These symptoms may not be harmful. However, they could be a sign of a heart problem, especially if:

• If they start after 20 weeks of pregnancy.
• If they affect you to the point where you can't do your normal daily activities.
• If you feel short of breath even when you are at rest.
• If you wake up in the middle of the night with difficulty breathing.

Unusual symptoms during pregnancy:

• Blurred vision.
• Chest pain (angina) .
• Heart palpitations lasting more than 30 seconds.
• Loss of consciousness (syncope) .
• Rapid heartbeat (tachycardia) .

Important: If you feel chest pain or discomfort, call 119 or your local emergency number immediately.

Tell your doctor about any symptoms you experience. It may be helpful to keep a diary of your symptoms. Include the following:

• All the symptoms you are feeling.
• Date and time.
• Severity on a scale of 1 to 10 (10 being the worst).
• What you are doing at the time (for example, exercising, doing light housework, or relaxing).

Symptoms are feelings or changes you experience. Signs are warning signs that your healthcare provider sees during a physical exam or tests. Signs of heart problems during pregnancy:

• Enlarged heart (cardiomegaly).
• Abnormal heart sounds (Heart murmur).
• High blood pressure.
• Presence of protein in the urine.
• Swelling of the veins in the neck (jugular venous distention).

Your doctor will check you for signs of heart problems at your prenatal clinic.

How to manage heart disease during pregnancy?

Medical treatment and self-care can help you manage heart disease during pregnancy. Here are some tips:

• Attend your doctor's appointments. You will likely be treated by an obstetrician-gynecologist and a cardiologist. Be sure to attend all of your appointments and follow-ups. You may need to have regular tests (including echocardiograms) to check your heart function.
• Avoid unnecessary weight gain. Ask your doctor how much weight you can safely gain during pregnancy.
• Avoid stress. As much as possible, avoid situations that make you feel stressed. Also, find ways to relax that help you feel calm. If your doctor says it's okay, prenatal yoga classes can help.
• Eat a heart-healthy diet. Follow your doctor's advice on what to eat and what to avoid. In general, try to limit your intake of sodium, sugar, saturated fat, and trans fat.
• Exercise safely. Your doctor will tell you how often you should exercise and what types of exercise are safe for you. Be sure to follow their instructions exactly. You may need to avoid activities that put too much strain on your heart.

Depending on your condition, your doctor may recommend a procedure to help your heart work better. It's usually best to have such procedures done before you get pregnant. Your medical team will assess your condition and decide the best course of action.

You may also need medication to manage certain conditions or risk factors. Talk to your doctor about which medications are safe and which are unsafe for you to take during pregnancy.

Cardiovascular disease medications during pregnancy

Part of your management plan is to take your medications exactly as prescribed. Your doctor may change your medications. This is because some heart medications are not safe to take during pregnancy.

Unsafe medications include:

• ACE inhibitors.
• Angiotensin receptor blockers (ARBs).
• Aldosterone antagonists.
• Some blood thinners, such as warfarin.
• Some medications that treat pulmonary hypertension, such as riociguat and bosentan.

Important: If you are taking any of these medications and become pregnant, call your healthcare provider immediately. Do not stop taking any medications without talking to a doctor.

Postpartum monitoring

Some complications can occur within six months after giving birth. Your medical team will monitor you and check your heart function. Even though you may be very busy and tired during this time, it is essential that you attend all your appointments. Your care team will also talk to you about the safety and risks of planning future pregnancies.

Will heart problems during pregnancy affect my future life?

Heart problems during pregnancy increase the risk of cardiovascular disease later in life. Here are some key statistics:

• Gestational diabetes increases the risk of cardiovascular disease in later life by 68%.
• High blood pressure during pregnancy increases the risk of cardiovascular disease by 67%.
• Preeclampsia increases the risk of dying from cardiovascular disease in later life by 75%.

These statistics may seem a little scary to you. But the good news is, statistics only tell part of the story. They are a reflection of what happened in the past. They don't have to determine your future. Use this knowledge to plan strategies to reduce your risk of cardiovascular disease. If you had any of these conditions during pregnancy or in the months after giving birth, talk to your doctor after giving birth and ask to be tested for cardiovascular disease.

There are many things you can do to prevent cardiovascular disease or slow its progression. You may need long-term follow-up with a cardiologist to monitor your heart health and detect early signs of problems. Talk to your care team about lifestyle changes that can help keep your heart and blood vessels healthy for years to come.

Finally, remember this.

If you have heart disease and are planning a pregnancy, now is the time to talk to your healthcare provider. Learn about your risks and how to manage your heart condition during pregnancy. If you have an unplanned pregnancy, it's important to talk to your doctor right away. Your doctor will assess your risk for complications. He or she may be able to change your heart medications to make them safe for pregnancy.

Even if you don't have heart disease, it's important to be aware of how unexpected heart problems can affect your pregnancy. Talk to your doctor about your risk factors. Work with your doctor to reduce your risk so you can have a safe and healthy pregnancy. Remember, a healthy mother gives a healthy baby the best start!

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