Pregnancy With Heart Disease

Overview

Pregnancy places major extra demands on the heart and circulation. Blood volume rises by roughly a third to a half, the heart pumps faster, and these changes peak in the second and third trimesters and around delivery. A healthy heart adapts easily, but when a person already has heart disease, this added workload can unmask or worsen problems.

Heart conditions in pregnancy may be present from birth (congenital), such as a hole in the heart or a repaired defect, or acquired, such as heart valve disease, weakened heart muscle, or arrhythmias. With careful planning and a coordinated team of obstetric and heart specialists, many people with heart disease have safe pregnancies, but some conditions carry serious risk and require expert guidance before and during pregnancy.

Symptoms

Mild breathlessness, fatigue, and ankle swelling are common in any pregnancy, which can make heart problems harder to spot. Symptoms that may point to the heart include:

• Shortness of breath at rest or when lying flat
• Rapid, pounding, or irregular heartbeat
• Chest pain or pressure
• Severe or sudden swelling of the legs, hands, or face
• Fainting or feeling about to faint
• Coughing, sometimes with frothy or blood-tinged sputum

Chest pain, fainting, severe breathlessness, or coughing up blood during pregnancy are emergencies. Call emergency services or go to the nearest emergency department right away.

Causes

The strain comes from normal pregnancy changes acting on a heart that cannot fully compensate. Underlying heart conditions include:

• Congenital heart disease: Defects present from birth, including repaired ones.
• Valve disease: Narrowed or leaky heart valves, sometimes from past rheumatic fever.
• Cardiomyopathy: A weakened or abnormal heart muscle, including a form that can develop late in pregnancy or after delivery (peripartum cardiomyopathy).
• Arrhythmias: Abnormal heart rhythms.
• Coronary artery disease and high blood pressure conditions.

Risk Factors

• A known congenital heart defect, repaired or unrepaired
• Heart valve disease or a prosthetic (artificial) valve
• Previous cardiomyopathy or heart failure, including in a past pregnancy
• Pulmonary hypertension (high pressure in the lung arteries), which is especially high risk
• Older maternal age, obesity, diabetes, or chronic high blood pressure
• A history of arrhythmia

Diagnosis

Ideally, heart disease is assessed before pregnancy so risks can be discussed in advance. During pregnancy, evaluation may include:

• Physical exam: Listening for murmurs and checking for signs of heart strain.
• Electrocardiogram (ECG): To record the heart's rhythm.
• Echocardiogram: An ultrasound of the heart that is safe in pregnancy and shows how the chambers and valves are working.
• Blood tests: Including markers of heart strain when heart failure is suspected.

The level of risk is graded so the care team can plan monitoring and delivery accordingly.

Treatment

Management is tailored to the specific heart condition and focuses on supporting the heart while keeping the pregnancy as safe as possible for parent and baby.

• Shared care: Regular visits with both an obstetrician and a cardiologist, often at a specialized center.
• Medication review: Some heart medicines are continued, while others are changed because they are unsafe in pregnancy; this should only be adjusted by a doctor.
• Activity and lifestyle: Rest, salt and fluid guidance, and watching weight gain as advised.
• Delivery planning: A clear plan for the timing, location, and method of delivery, with extra monitoring during labor and in the days afterward when the heart's workload shifts again.

Some procedures, such as valve repair, may occasionally be needed during pregnancy in specialized settings.

Prevention

Heart disease cannot always be prevented, but risks during pregnancy can be reduced:

• Seek pre-pregnancy counseling if you have a known heart condition, so risk can be assessed before conceiving
• Keep blood pressure, diabetes, and weight well controlled
• Attend all prenatal and cardiology appointments
• Take only medications confirmed safe by your care team, and never stop heart medicine on your own
• Report new symptoms promptly

When to See a Doctor

Contact your care team promptly if you notice worsening breathlessness, new or frequent palpitations, or rapidly increasing swelling. Seek emergency care immediately for:

• Chest pain or pressure
• Severe shortness of breath or trouble breathing when lying down
• Fainting or near-fainting
• Coughing up blood or pink, frothy sputum
• A very fast or irregular heartbeat with dizziness

Related Topics

Frequently Asked Questions

References

1. American Heart Association. Heart Disease and Pregnancy.
2. Mayo Clinic. Pregnancy and heart conditions.
3. MedlinePlus, U.S. National Library of Medicine. Pregnancy and heart disease.
4. American College of Obstetricians and Gynecologists (ACOG). Pregnancy and Heart Disease.