Heart problems pose a challenge for doctors when treating any type of patient. But when more than one life needs to be accounted for? That can ratchet up the potential problems.
Heart disease remains the No. 1 cause of death for women in the United States, according to the Centers for Disease Control and Prevention. And while the risk generally increases with age, the rate of younger people with heart conditions is rising.
That can become especially troublesome when a woman is pregnant. The heart works harder during pregnancy, pumping faster to circulate your blood throughout the body. Meanwhile, your blood volume increases, your heart rate rises, and your blood pressure drops.
Heart failure during pregnancy, while rare, can happen. And ensuring the health of both mother and child is both crucial and difficult.
UPMC’s Heart and Vascular Institute and the UPMC Magee-Womens Hospital’s Department of Maternal Fetal Medicine work closely together to do that. The two departments team up during high-risk cardiovascular pregnancies and births, from diagnosis through treatment.
“This really requires a team approach,” says Ravi Ramani, MD, a cardiologist and director of the UPMC Integrated Heart Failure Program. “They’ll come up to us or we’ll go down to them to co-manage the baby.”
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Heart and Vascular Problems Before Pregnancy
Recent studies are showing that heart conditions are rising in younger adults, particularly among women.
If women have heart conditions before becoming pregnant, they are at greater risk during pregnancy. Some heart disorders can make it inadvisable to become pregnant because of the risk of death. Others can cause damage to your baby.
It’s important to consult a doctor if you have a heart condition and are pregnant or wish to become pregnant.
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Heart and Vascular Problems During Pregnancy
Peripartum cardiomyopathy, or PCM, is a rare but life-threatening heart condition that develops either late in pregnancy or soon after delivery. It can be difficult to diagnose because many of its symptoms – such as shortness of breath, swelling in the legs and feet – are similar to normal pregnancy, Dr. Ramani says.
But if doctors do diagnose a heart problem during pregnancy, they gear their treatment to the health of both mother and baby.
One issue is with medication, usually the first course of treatment for heart problems.
“A lot of the medicines we use to treat people with weak hearts may be toxic to the fetus,” Dr. Ramani says. “Things like the most common blood thinner. There are a lot of other medicines where either it is unknown or it is risky to continue to treat the mom because of the risk to the baby.”
Doctors use other medicines when necessary to avoid harm to the baby.
If a heart condition does not improve with medicine, doctors sometimes take bigger steps: a heart assist device or even a transplant. Those can’t be done during pregnancy, so sometimes an early delivery is needed.
“We have to weigh sometimes, unfortunately, the risk of the mother versus the risk of the baby,” Dr. Ramani says. “Those are hard decisions, and factoring into this is the person’s choices and beliefs.”
It leads to some difficult conversations, Dr. Ramani says, especially in cases where the conception was difficult.
“You have to remember this is a catastrophic situation, many times,” Dr. Ramani says. “The way we do this is present various options to the patient and family and go through various scenarios. We do so in a combined manner from all of the team members.
“It’s a hard choice, and sometimes I feel it’s unfair to the patient to have to make this decision or the patient’s family to make the decision on it. But I strongly feel that everybody needs to be informed and make a decision based on the best available information.”
If a mother does need a transplant or assist device, doctors usually deliver the baby by C-section to avoid stress to her heart.
Post-Pregnancy Heart and Vascular Challenges
Many times, the stresses to the heart go away after a baby is born. But there still can be challenges after delivery.
Some of the medicines used can be secreted through breast milk, so doctors must be careful with what they prescribe. In cases where a heart assist device or transplant is needed, breastfeeding should be avoided.
The situation at home also should be monitored. Bringing a newborn home can create extra stress or fatigue that’s bad for someone with a heart condition.
“There may be an issue with just being physically able to care for the baby,” Dr. Ramani says. “You’re relying on a huge amount of time on significant others or family to take care of the baby. It’s a huge lift.”
Even if your heart problems go away after delivery, it’s important to keep following up with your doctors. Some pregnancy-related conditions, such as preeclampsia or high blood pressure, can lead to heart and vascular problems later.
The motivation is high in many mothers, Dr. Ramani says. They want to make sure they’re healthy enough to raise their children.
The UPMC Heart and Vascular Institute has long been a leader in cardiovascular care, with a rich history in clinical research and innovation. As one of the first heart transplant centers in the country and as the developer of one of the first heart-assist devices, UPMC has contributed to advancing the field of cardiovascular medicine.