People of any age or gender can be affected by heart disease and other cardiovascular diseases, but pregnant women are particularly vulnerable and may even suffer maternal death. Heart disease during pregnancy not only makes it difficult for women to maintain their normal activities, but it can also lead to complications for both mum and baby in the later stages of pregnancy.
The heart is a main player in how the body functions during pregnancy, but for women with existing heart conditions or who are at risk of developing them, there are certain risks that come along with the condition. When it comes to how pregnancy affects the heart, there are different types of heart disorders that can develop during pregnancy such as peripartum cardiomyopathy, hypertension and coronary artery disease.
Some women are at a higher risk of developing certain types of heart conditions. These women may need to be closely monitored by their doctors throughout their pregnancy.
Primary Causes of Heart Disease During Pregnancy
The different types of heart disease in pregnancy have the potential to be life-threatening for both mother and child if not treated promptly. Women who have a pre-existing heart condition, such as congenital heart disease, should consult a healthcare professional who specialises in cardiac diseases to avoid pregnancy complications such as birth defects or premature birth. However, it's worth noting that even an individual who doesn't have a pre-existing heart disease can potentially develop a heart condition during pregnancy. A number of factors may increase the risk of heart failure in pregnant women.
For example, peripartum cardiomyopathy is a potential risk for congestive heart failure, which could result in collapse or even death for both mum and baby in labour, if not detected quickly enough. Peripartum cardiomyopathy is a type of heart failure in which the heart muscle becomes weak and unable to pump enough blood to meet the body's needs. The cause for this weakening of the muscles is still unknown, but women who have had multiple pregnancies are at an increased risk.
Another type of heart disorder during pregnancy is hypertension or high blood pressure. This condition typically occurs later on in the third trimester due to fluid retention and excess protein in the urine. The condition puts too much strain on the circulatory system to supply adequate nutrients and oxygen to both mother and child while simultaneously removing waste products from fetal circulation. This increase in demand results in higher blood pressure.
A heart murmur is a condition caused by an increase in blood volume during pregnancy. It makes a strange sound as a result of the abnormal flow of blood through the heart valves, indicating that there is an unbalanced pressure present. This sort of disorder frequently occurs during pregnancy because the heart has to work harder than usual to meet the demands of the growing infant. However, heart murmurs may not be serious and cause no symptoms, or they may progress to a more serious condition such as aortic valve stenosis.
Older pregnant women are at a higher risk of developing coronary heart disease, a medical condition that damages the pulmonary arteries as a result of fatty deposits accumulating inside them. A history of a medical condition, such as gestational diabetes or high blood pressure, raises the risk of this type of heart disease, which can lead to cardiac arrest.
Myocardial infarction, also known as a heart attack, is another heart condition that can affect pregnant patients. Myocardial infarction in pregnancy is caused by blood clots in the blood vessels, which obstruct blood flow and rip the artery walls. A myocardial infarction occurs in 30% of pregnancies and is classified into three types: anterior wall infarctions, inferior wall infarctions and lateral wall infarctions. Anterior wall infarction can result in a significant decrease in the amount of oxygen required by both the mother and the baby. Inferior wall infarction is commonly associated with hypertension and can result in congestive heart failure. This is due to the inferior wall having less cardiac reserve. Lateral wall infarctions are commonly associated with haemorrhage during the postpartum period and can also result in infarction of the left anterior descending artery.
Source: American College of Cardiology
Symptoms of Heart Disease During Pregnancy
Women with heart disease exhibit a variety of symptoms depending on the severity of their condition. Some may appear subtle, but they must be paid attention to because they may indicate serious issues such as cardiac arrest or heart failure, which occur when there is insufficient blood flow from the heart for either mother or child.
The common symptoms of heart disease during pregnancy include:
- Chest pain
- Shortness of breath
- Rapid heart rate
They typically appear around 20 weeks of pregnancy or after the second trimester. Reduced physical activity, swelling of the abdomen and a persistent cough with blood in the phlegm are all signs of heart failure. If these symptoms are not treated, they can progress to other health conditions.
Who is at Risk of Heart Diseases During Pregnancy?
Some people, such as older adults and those with a genetic predisposition to cardiovascular disease, are more likely to develop certain types of heart conditions. Women with heart disease may require close monitoring by their healthcare provider to ensure a healthy pregnancy and proper management of their heart disease.
Diagnosis and Treatment of Heart Diseases During Pregnancy
Depending on what type of heart disorder a pregnant woman has, the diagnostic process will vary greatly. Diagnosing heart disease can be difficult because some symptoms can overlap with those caused by other health conditions such as the flu or pneumonia. Other issues which arise during pregnancy, such as nausea, vomiting and fatigue can also mimic signs of heart problems.
To combat these difficulties and pinpoint the diagnosis more accurately, healthcare professionals may use an electrocardiogram (EKG), echocardiogram (ECG), stress test or chest X-ray in addition to performing a physical exam. Furthermore, additional tests that are only performed during pregnancy may be recommended, such as amniocentesis, chorionic villus sampling or fetal heart monitoring. These tests can detect not only the condition of the heart but also heart disease complications during pregnancy. It can also detect fetal distress, which serves as a biomarker of the unborn child's risk of developing a congenital heart defect.
Treatment for pregnant women with heart disease will vary depending on the disorder and how far along she is in her pregnancy. Some more common treatments include bedrest, medication, oxygen therapy and surgery. If the pregnant woman has an infection, it will be treated with antibiotics. Additionally, if her symptoms relate to high blood pressure or low blood pressure, medication may be prescribed. Furthermore, some people may need more extensive treatment involving cardiac catheterization, angioplasty, or a coronary artery bypass graft.
How to Prevent Congenital Heart Defects
Birth defects refer to a problem that was present at birth that changed how organs or tissues developed before birth. More often than not, the defect results from abnormal cell division or abnormal tissue growth. There are different types of congenital heart defects, including a hole in the heart, abnormal development of heart valves and a problem with the ventricular function, among others.
Infants born with congenital heart defects may experience additional issues as a result of how their hearts developed, such as slow growth or developmental delays. They may also have problems that can affect how they function in daily life, like lung infections and gastrointestinal disease.
Heart surgery is an important part of treating children who suffer from congenital heart defects. Even if babies appear healthy right after birth, once they get older they will experience cardiac complications. In some cases, babies with congenital heart disease don't survive even with treatment. In other cases, CHDs can be corrected through surgery or medication.
To prevent any risk of complications during pregnancy, women should avoid smoking and drinking alcohol, and they must take folic acid supplements to prevent neural tube and cardiovascular defects. To reduce the risk of other birth defects, it pays to follow a healthy lifestyle, which includes getting regular exercise, eating healthy food, maintaining a healthy weight, getting 7 to 8 hours of sleep and maintaining a positive mindset.
It is also critical to have a self-care management plan in place. Having a pulse oximeter on hand and reporting any irregular pulse or heart rate to your healthcare provider right away will help prevent atrial fibrillation or other conditions from worsening.
There is no way to predict how a child's heart will develop during pregnancy or how it will function after birth. However, continued prenatal care of both mother and fetus can help ameliorate how potential problems are identified and treated at an earlier stage of development.