www.tidewaterreview.com/features/health/ct-x-heart-pregnancy-20130220,0,1754630.story

tidewaterreview.com

The heart in pregnancy

Being pregnant can exacerbate some heart conditions and alleviate others. What's most important is talking to a doctor before trying to conceive to see if you are at risk.

By Amanda Marrazzo, Special to the Tribune

February 20, 2013

Advertisement

Jamie Feld followed all the pre-pregnancy advice, had a checkup before conceiving and was told she was fit and healthy to carry her first baby.

Throughout her pregnancy, the Northbrook resident kept up with all prenatal appointments, and all seemed well until the eighth month.

"In the last few weeks I really did feel something wasn't right," said Feld, 37.

Physicians discovered that Feld's excessive weight gain (she gained 30 pounds in the last five weeks of pregnancy), extremely difficult breathing, excessive swelling of her legs and rising blood pressure were all signs of congestive heart failure.

Feld was diagnosed with peripartum cardiomyopathy, a rare disorder in which the heart becomes weakened.

The baby she was carrying is today a healthy 7-year-old girl, whom she treasures. But she had hoped to have more children.

Doctors said it would be too dangerous for Feld to carry another baby, so she has no plans on getting pregnant again.

"It has become something we have come to accept," Feld said. "She is everything to us and as parents we are very fulfilled."

Dr. Annabelle Volgman, professor of medicine and medical director of the Rush Heart Center for Women, said heart conditions arising during pregnancies are not overly common, but they do occur and must be taken seriously. Feld is a patient of Volgman's.

"There (are) definitely certain conditions when we advise the woman not get pregnant," Volgman said. "But there are conditions where pregnancy is safe and might improve (an existing) heart condition."

In Feld's case of peripartum cardiomyopathy, which typically occurs in the last trimester and within the first six months after delivery, doctors caution against future pregnancies.

Ironically, in cases of a women having an existing heart condition known as vasodepressor syncope — in which a woman loses consciousness due to dehydration or an abnormal reflex within the heart — pregnancy is welcomed.

"The treatment (for vasodepressor syncope) is to hydrate the patient," Volgman said. "So, when they get pregnant, they are in the high volume state (of fluids. They tend to retain water, have more fluid in their bodies than normal ... This tends to improve this ... heart condition."

Mitral valve prolapse is another heart condition where pregnancy is welcomed, she said.

Volgman warns against pregnancy for women who have had heart failure, congenital heart defects with shunting, pulmonary hypertension and primary pulmonary hypertension.

But even with a doctor's warning sometimes women with life-threatening heart conditions get pregnant. When this happens, Volgman said it is difficult, but as a cardiologist she needs to have a "terrible" conversation with the woman.

"We have to make a decision, if it is safe to continue the pregnancy or terminate the pregnancy," she said.

In these situations religious and moral issues often arise and parents must decide between the baby and risking the mother's life.

"It's hard to for us to deal with these women that don't listen when told to not get pregnant," she said. "We don't want our patients to have to go through this. We are scared for them and when they go ahead and get pregnant, it's hard."

In other scenarios, a woman does not know she has a heart condition until she becomes pregnant, or she has a condition that only arises when pregnant, such as the case with Christine Lutz of Chicago.

Lutz, 34, is otherwise healthy, but during both of her pregnancies she developed a heart condition.

About four months into her first pregnancy, she felt an extra heartbeat. A cardiologist said it was common to have some palpitations during pregnancy and monitored it but did not feel the need to treat it with medicine.

But within the first weeks of her second pregnancy, Lutz felt several extra beats and this time there was chest pain and tightness.

"With my second pregnancy I had a lot more symptoms ... chest pain, an awareness that I was having more, extra heartbeats, four or five in a row," Lutz recalled.

This time around doctors monitored and tested Lutz condition regularly. She was diagnosed with an arrhythmia.

She was prescribed beta blockers, which are safe during pregnancy, to manage her condition. She continued on with the pregnancy. The baby was born healthy and Lutz has since weened off of the medicine.

She said there were no plans to have more children after their second, but should she get pregnant she would be monitored closely and require certain precautions.

She warns others to listen to their bodies.

"If you have any concerns at all follow up with your doctor," she said. "It is so important for you and the health of the baby to make sure your body is functioning properly."

Dr. Marla Mendelson is a cardiologist and medical director of the Program for Women's Cardiovascular Health at Northwestern's Bluhm Cardiovascular Institute.

Mendelson said nowadays there are more older women having babies, and women who as children had heart diseases, and now want to have babies. These scenarios increase the need for pre-pregnancy evaluations.

"The risk of coronary disease and hypertension increase with age especially over 40," Mendelson said.

"Unfortunately there are still a lot of adults, despite all of our advances, walking around and not being diagnosed with a heart disease."

However, she adds, that "fortunately the overall incidence of heart disease in pregnancy is still less than 5 percent."

Regardless, physicians insist, all women either with or without prior heart issues be evaluated preconception.