Heart Palpitations And Shortness Of Breath During Pregnancy

A difficult diagnosis

“Peripartum cardiomyopathy often goes undiagnosed because there is so much overlap with the symptoms of a normal pregnancy,” says Michigan Medicine cardiologist Melinda Davis, M.D., who specializes in pregnancy and women’s cardiology. “This is why the condition is commonly misdiagnosed.”

In addition, many women may experience mild symptoms of a typical pregnancy, such as shortness of breath and swelling, Davis reminds women. But her objective is to raise awareness of PPCM and the signs that women should be on the lookout for.

Although the prevalence of PPCM appears to be increasing, she says it’s difficult to determine whether this is due to the condition actually becoming more common or to advancements in diagnosis methods.

Davis advises women with severe symptoms to consult their doctors about additional testing, noting that the condition is frequently diagnosed by exclusion.

She adds that a blood test to measure the B-type natriuretic peptide hormone can be helpful and an echocardiogram can measure the heart’s ejection fraction to determine if heart failure is the cause of the symptoms. “Women can be tested for fluid overload from the heart to rule out PPCM,” she says.

Davis emphasizes the significance of understanding your family’s medical history despite the fact that the majority of PPCM patients do not have a genetic history of cardiomyopathy. For instance, Mitchell’s father’s death from cardiomyopathy raises the possibility that PPCM is inherited in her family.

Most women receive their diagnosis after giving birth, unlike Mitchell who received it while she was pregnant.

According to Davis, the body absorbs a lot of fluid following pregnancy, which can worsen postpartum symptoms and lead to peripartum cardiomyopathy and heart failure.

In the weeks and months following delivery, she advises women to discuss any severe breathing issues or problems with fluid retention with their doctors.

Cardiac arrhythmias are more common during pregnancy, according to clinical experience and published data (mostly anecdotal)14–16. According to one study13), normal, healthy patients who present with symptoms during pregnancy—most commonly palpitations—have a high incidence of ectopic activity. It was discovered that 20% of these patients had Pregnancy’s arrhythmogenic effect was amply demonstrated by a significant drop in the incidence of ectopic activity in a subgroup of these patients whose Holter monitoring was repeated postpartum.

Dyspnea is a common feature of pregnancy. Although it rarely causes clinically significant symptoms, when it does it can be incapacitating for the patient and perplexing for the doctor. It can also present a challenging diagnostic challenge in patients with known or suspected heart disease. Some expectant women also express discomfort at being aware of their heart palpitating. In fact, during pregnancy, the symptoms are frequently used as cardio-respiratory reasons for referral to the cardiologic or pulmonary clinic.

There have been few systematic studies of the incidence, severity, and time-course of gestational dyspnea and palpitation in a group of healthy women7, 13, despite the fact that a number of theories have been proposed to explain their causes. Such information would be useful for managing patients with pre-existing cardiorespiratory disease who become pregnant as well as for determining the cause of these symptoms in pregnancy.

Dyspnea is common during normal pregnancy. About half of women with no history of cardio-respiratory disease have been reported to experience dyspnea before the 19 week of gestation and 76% complain of this symptom by the 31 week7) However, as evidenced by our study, fewer women than in the prior study complained of it7). The information was gathered retroactively based on recall, so it’s possible that dyspnea that wasn’t severe enough to interfere with daily life went unreported. It’s also possible that this is because dyspnea gets better as term approaches and almost never, if ever, complicates labor and delivery. In any case, dyspnea is typically overshadowed at that time by the more urgent symptom of pain and rarely affects daily life9). Finally, the dyspnea is gone when the patient returns for her postpartum examination. These factors may account for the discrepancy between our study’s findings and those of an earlier prospective interview study7).

Increased sympathetic activity has been suggested as a mechanism for an increased incidence of arrhythmias during pregnancy12) and may be connected to symptoms like palpitations. However, catecholamine levels, which have been reported to be either the same or even lower in pregnancy when compared to the nonpregnant state17, 18), do not support such a mechanism. Because of this, the cause of symptoms is frequently unknown, and their presence does not indicate a cardiac arrhythmia. In the absence of concurrent cardiac arrhythmias, a common sensation of palpitation may also be linked to physiologic modifications that take place during pregnancy, such as elevated heart rate, decreased peripheral resistance, and elevated stroke volume19).

How can I make sure my baby is OK?

Throughout your pregnancy, your healthcare provider will keep an eye on your baby’s development. Regular ultrasound examinations can be used to monitor your child’s development, and specialized ultrasounds can be used to look for fetal heart defects. Observation or care for your newborn may be required after delivery as well.

The best way to care for your baby is to take good care of yourself. For example:

  • Keep your prenatal appointments. Visit your health care provider regularly throughout your pregnancy.
  • Take your medication as prescribed. Your health care provider will prescribe the safest medication at the most appropriate dose.
  • Get plenty of rest. Take a daily nap, if you can, and avoid strenuous physical activities.
  • Monitor your weight gain. Gaining the right amount of weight supports your babys growth and development. Gaining too much weight places additional stress on your heart.
  • Manage anxiety. Ask questions about your progress. Find out what to expect during labor and delivery. Knowing whats happening can help you feel more at ease.
  • Know whats off-limits. Avoid smoking, alcohol, caffeine and illegal drugs.
  • Why do I get increased heart rate and shortness of breath after 20 weeks of pregnancy?

    Leave a Comment