Heart Disease in Pregnancy - Signs, Risks and Solutions

Women with pre-existing heart diseases are at an increased risk of developing a cardiac disease in pregnancy. Some of the common pre-existing heart diseases that can affect pregnancy include:

1. Cardiomyopathy: The illness known as cardiomyopathy causes the heart muscle to weaken, expand, or stiffen. This makes it difficult for the heart to pump blood efficiently throughout the body.
   During pregnancy, the body's demand for blood and oxygen increases, which can put additional stress on the heart. Women with cardiomyopathy may experience symptoms such as shortness of breath, fatigue, chest pain, and palpitations.
   They also have a higher chance of getting heart failure as well, which happens when the heart cannot pump enough blood to meet the body's requirements. In severe cases, cardiomyopathy can lead to life-threatening complications such as arrhythmias and blood clots.
2. Aortic Disease: The aorta is the largest artery in the body and carries oxygenated blood from the heart to the rest of the body. Aortic disease refers to conditions that affect the structure and function of the aorta.
   Pregnant women with aortic disease are at an increased risk of developing aortic dissection, which is a tear in the inner layer of the aorta. Aortic dissection can cause severe pain in the chest, back, or abdomen and can be life-threatening if left untreated.
   Other complications of aortic disease during pregnancy include heart failure, arrhythmias, and high blood pressure.
3. Congenital Heart Disease: Congenital heart disease is a condition that affects the structure and function of the heart that is present at birth. Women with congenital heart disease may experience complications during pregnancy due to the increased demand for blood and oxygen.
   The severity of the condition depends on the type and extent of the heart defect. Some women with mild congenital heart disease may have a relatively normal pregnancy and delivery, while others may experience complications such as heart failure, arrhythmias, and high blood pressure.
4. Heart Valve Disease: Heart valve disease occurs when one or more of the heart valves do not work properly. The heart valves regulate blood flow in and out of the heart. During pregnancy, the increased demand for blood and oxygen can put additional stress on the heart valves.
   Women with heart valve disease may experience symptoms such as shortness of breath, fatigue, chest pain, and palpitations. They are also at an increased risk of developing heart failure, arrhythmias, and blood clots.
5. Arrhythmias: Arrhythmias refer to abnormal heart rhythms that can range from mild to life-threatening. During pregnancy, hormonal changes and increased demand for blood and oxygen can trigger arrhythmias in women with pre-existing heart conditions.
   Some arrhythmias may not cause any symptoms, while others can cause palpitations, dizziness, fainting, and shortness of breath. Treatment for arrhythmias during pregnancy depends on the severity and type of the arrhythmia.
6. Pulmonary Hypertension: Pulmonary hypertension is a condition that affects the blood vessels in the lungs. It occurs when the blood vessels become narrow and stiff, making it difficult for the heart to pump blood to the lungs.
   Women with pulmonary hypertension are at an increased risk of developing heart failure and blood clots during pregnancy. Symptoms of pulmonary hypertension may include shortness of breath, fatigue, chest pain, and swelling in the legs and ankles.

The heart is actively involved in multiple anatomical activities of pregnant ladies, which is why most women suffer minor to major heart diseases during pregnancy. Listed below are the most common heart problems among pregnant women:

1. Blood Volume Alterations: The earliest heart-related irregularity pregnant women can potentially develop increased blood volume. This happens primarily due to two reasons.
   1. One, there is excessive production of hormones by the reproductive organs, and 
   2. Two, because of uteroplacental circulation (the blood flow between the mother's uterus and the placenta, which provides oxygen and nutrients to the developing foetus).
      The blood volume may increase by 40 to 45% in the first trimester and will keep constant or increase further during pregnancy.
2. Gestational Diabetes: During the second trimester, i.e., after 20 weeks of pregnancy, mothers can develop high sugar levels. Weight gain and insulin resistance are the most common factors affecting the problem and can put the baby and the mother at risk.
3. ​​Spontaneous Coronary Artery Dissection (SCAD): SCAD is a rare but serious condition in which a tear occurs in one of the blood vessels supplying the heart.
   During pregnancy, hormonal changes and the increased demand for blood and oxygen can increase the risk of developing SCAD. Symptoms of SCAD may include chest pain, shortness of breath, and nausea. Treatment for SCAD during pregnancy may include medications and, in severe cases, angioplasty or bypass surgery.
4. Increased Cardiac Output: To pump the blood in more volume, the heart will function more efficiently. This efficiency is known as cardiac output.
   However, women do not experience an increase in cardiac output until their third trimester because the baby will grow from a zygote to a foetus only during this time.
   On average, the cardiac output is expected to be increased by 30 to 50 per cent, and it can go up to 60 per cent in the case of twins.
5. Hypertension: Hypertension, or high blood pressure, is a common condition that can develop during pregnancy. It can lead to complications such as preeclampsia, a serious condition affecting both the mother and the foetus.
   Symptoms of hypertension during pregnancy may include headache, blurred vision, and swelling in the hands and feet. Treatment for hypertension during pregnancy may include medications and close monitoring of blood pressure levels.
6. Irregularity in Rhythm: Increased cardiac output will, in turn, induce fast heart rhythms. Generally, the heart rate increases by 10 to 20 rhythms in a minute in the third trimester.
   Sometimes, the heart rate is irregular and is known as arrhythmias. In most cases, it is harmless, but if it gets complicated, the same medication shall be given to a pregnant lady as would be given to a regular heart patient.
7. Myocardial Ischemia: Myocardial ischemia occurs when the heart muscle does not receive enough oxygen and nutrients due to reduced blood flow.
   During pregnancy, the increased demand for blood and oxygen can increase the risk of developing myocardial ischemia.Symptoms of myocardial ischemia may include chest pain, shortness of breath, and fatigue. Treatment for myocardial ischemia during pregnancy may include medications and, in severe cases, angioplasty or bypass surgery.
8. Peripartum Cardiomyopathy (PPCM): PPCM is a rare but serious form of heart failure that occurs during the last month of pregnancy or in the months following delivery.
   The cause of PPCM is not fully understood, but it is thought to be related to hormonal changes and inflammation. One may experience symptoms of PPCM, like shortness of breath, fatigue, and swelling in the legs and feet. Treatment for PPCM may include medications and, in severe cases, a heart transplant.

Heart problems during pregnancy can increase the risk of maternal and foetal complications, including preeclampsia, caesarean delivery, and long-term health effects. While women may be dealing with the most common heart disease in pregnancy, there are many risk factors that one must be aware of. 

Close monitoring and prompt treatment are important to minimise these risks and ensure the best possible outcomes for both the mother and the foetus. Some of the most highlighted risks associated with heart problems during pregnancy include:

1. Maternal Complications: Heart problems during pregnancy can increase the risk of maternal complications such as heart failure, stroke, and blood clots. These complications can be life-threatening for the mother and may require hospitalisation or intensive medical care.
2. Foetal Complications: Heart problems during pregnancy can also increase the risk of foetal complications such as preterm birth, low birth weight, and stillbirth. These complications can be caused by reduced blood flow to the placenta, which can affect foetal growth and development.
3. Preeclampsia: Preeclampsia is a serious condition that can occur during pregnancy and is characterised by high blood pressure and damage to organs such as the liver and kidneys.
   Women with heart problems are at an increased risk of developing preeclampsia, which can lead to complications for both the mother and the foetus.
4. Caesarean Delivery: Women with heart problems may be more likely to require a caesarean delivery (C-section) due to the increased risk of maternal and foetal complications.
   C-sections are major surgical procedures that can increase the risk of complications such as infection, bleeding, and blood clots.
5. Long-term Health Effects: Heart problems during pregnancy can also have long-term health effects for both the mother and the child. Women with heart problems may be at an increased risk of developing cardiovascular disease later in life.
   Children born to mothers with heart problems may be at an increased risk of developing heart problems themselves.

Heart diseases in pregnancy do not come unannounced; they always give prior signs. Chest pain, or angina, is the most profound symptom of heart problems during pregnancy. It happens due to a lack of oxygen-rich blood reaching the heart. 

It is difficult to distinguish angina from other kinds of chest pains, but if one feels squeezing, pressure, heaviness, tightness, or pain in the chest, take it as one related to the heart. Other symptoms of cardiac disease in pregnancy are nausea, fatigue, severe shortness of breath, swelling of the lower body, excessive urination during the night, etc.

The physiological changes during pregnancy are highly pronounced in the cardiovascular system of the human body. Congenital heart diseases, i.e., ones since birth, make pregnancy difficult. If the birth of the baby is pre-planned, mothers with such heart diseases should consult the doctors before getting pregnant. 

Specialists should be consulted in cases of unplanned pregnancy. Cardiomyopathy, i.e., the inefficiency of heart muscles to pump extra blood, and valve issues are other pre-existing factors that can endanger the baby and the mother during pregnancy.

Besides these, other high-risk factors that can affect heart diseases during pregnancy are:

1. Women more than the age of 30 have multiple pregnancies or have a history of complicated pregnancies. 
2. Consistent alcohol and drug abuse
3. Obesity with a 30+ BMI
4. High blood pressure
5. Poor nutrition

Depending on the adversity of the disease, there are multiple ways to treat cardiovascular diseases during pregnancy. Something as simple as lifestyle changes can help patients with better recovery. 

The specific treatment for heart disease during pregnancy will depend on the specific type and severity of the condition. In general, the treatment approach will aim to manage symptoms, prevent complications, and ensure the well-being of both the mother and the baby.

Some of the different treatment options for heart disease during pregnancy include:

Lifestyle Changes

Lifestyle changes such has shown to be effective in treating heart disease in pregnancy, as these changes can help reduce the risk of complications during pregnancy and improve overall cardiovascular health. 

Here are some lifestyle changes that can be a treatment for heart disease during pregnancy:

1. Eating a heart-healthy diet low in saturated and trans fats, cholesterol, and salt and high in fruits, vegetables, whole grains, and lean protein sources.
2. Maintaining a healthy weight through healthy eating and regular exercise.
3. Getting regular exercise, such as walking, swimming, or prenatal yoga, is recommended by a healthcare provider.
4. Avoid tobacco, secondhand smoke, and other harmful substances such as alcohol and illegal drugs.
5. Managing stress through relaxation techniques such as meditation, deep breathing, or prenatal massage.
6. Monitoring blood pressure and blood sugar levels as recommended by a healthcare provider.
7. Avoiding certain medications or substances that may be harmful to the developing foetus, as recommended by a healthcare provider.
8. Getting adequate rest and sleep to support overall health and well-being.

Medications

Medications may be used to control blood pressure, reduce swelling, or prevent blood clots, depending on the specific type and severity of the heart condition. However, not all medications are safe to use during pregnancy, so it's important to discuss the risks and benefits of any medication with a healthcare provider.

Procedures

In some cases, procedures such as cardiac catheterisation or open-heart surgery may be necessary to repair or treat heart problems. Some common procedures that can be a treatment for heart disease during pregnancy include:

1. Cardiac Catheterisation: This is a minimally invasive procedure that can be used to diagnose and treat certain heart conditions. During cardiac catheterisation, a thin tube is inserted into a blood vessel in the arm or leg and guided to the heart.
   The healthcare provider can use this tube to perform diagnostic tests or treat certain heart conditions, such as opening blocked arteries.
2. Open-heart Surgery: In some cases, open-heart surgery may be necessary to repair or replace a heart valve, correct a congenital heart defect, or treat other serious heart conditions. This is a major surgery that is typically performed under general anaesthesia.
3. Pacemaker or Defibrillator Implantation: If a woman has a heart rhythm disorder, a pacemaker or defibrillator may be implanted to help regulate the heart's rhythm. This is a minor surgical procedure that involves implanting a small device under the skin.
4. Balloon valvuloplasty: This is a minimally invasive procedure that can be used to treat certain heart valve conditions. During a balloon valvuloplasty, a catheter with a balloon at the end is inserted into a blood vessel and guided to the heart.
   The balloon is then inflated to widen the valve opening and improve blood flow.

Monitoring

Women with heart disease during pregnancy will require close monitoring by a team of healthcare providers, including an obstetrician, cardiologist, and other specialists, as needed.

This monitoring may involve regular ultrasounds to check the baby's growth and well-being, as well as frequent appointments to check the mother's heart function and overall health.

Delivery Options

The method of delivery may also be influenced by the woman's heart condition, with some women with severe heart disease requiring a planned c-section to reduce the risk of complications during delivery.

The delivery timing may also be needed to be carefully planned to ensure the best possible outcome for both the mother and the baby.

Postpartum Care

Women with heart disease will require ongoing postpartum care to ensure that any complications are identified and managed promptly. This may involve additional monitoring of the mother's heart function and overall health, as well as monitoring of the baby's health and development.

Women with heart disease need to continue to work closely with their healthcare providers after delivery to ensure the best possible outcomes.

It’s important for women with heart disease who are pregnant or planning to become pregnant to work closely with a team of healthcare providers, including an obstetrician, cardiologist, and other specialists as needed, to ensure the best possible outcome for both themselves and their babies.

It is crucial to seek medical attention promptly if a woman has a pre-existing heart condition or experiences heart problems during pregnancy. Symptoms of heart issues during pregnancy may include chest pain, difficulty breathing, fainting or dizziness, irregular or rapid heartbeat, or swelling in the legs, feet, or ankles. 

These symptoms could indicate severe complications like heart failure and must be evaluated by a healthcare provider immediately. Women with existing heart conditions must also consult a doctor before attempting to conceive to ensure their heart condition is stable and to take necessary precautions for a safe pregnancy.

In conclusion, it is evident that heart diseases in pregnancy have different forms and effects. Some people may not experience extreme challenges during pregnancy, while others may be at a death risk. 

First-time mothers should be extra cautious about their pregnancy because this phase is fairly new to them, and everybody has a different response to it. But this doesn’t mean that people giving birth for the second or third time should not bother at all. One must pay regular visits to the doctor to ensure a safe pregnancy. 

We at HexaHealth are here to help you get top-notch medical assistance during your pregnancy. Our team of dedicated experts put their years of experience into action and strive to keep both the mother and baby safe during childbirth. You can connect with us today and start your consultation with ease.