Heart Failure in Pregnancy – Introduction

Pregnancy is a unique journey that brings immense joy and profound changes to a woman’s body. However, this period can also unveil or exacerbate certain health conditions, including heart failure. Globally, heart disease remains a leading cause of maternal mortality, with heart failure complicating approximately 0.1% of pregnancies. In India, rheumatic heart disease accounts for about 90% of heart failure cases during pregnancy.

Renowned cardiac surgeon Dr. Vishal Khullar emphasizes,

“Pregnancy places additional stress on the heart, making it crucial for women with pre-existing conditions to consult their doctor early. Regular check-ups and open discussions with a medical team can help identify potential risks and ensure timely interventions, significantly reducing complications.”

Heart failure during pregnancy can stem from various underlying conditions:

Rheumatic Heart Disease (RHD): In regions like India, RHD is prevalent and often leads to heart failure in pregnant women. Valvular lesions, such as mitral stenosis or regurgitation, can worsen due to increased blood volume during pregnancy.

Peripartum Cardiomyopathy (PPCM): This rare disorder weakens the heart muscle, leading to heart failure in the last month of pregnancy or within five months postpartum.

Congenital Heart Disease (CHD): Women with untreated or complex congenital heart defects face increased risks during pregnancy.

Hypertensive Disorders: Conditions like preeclampsia elevate blood pressure, increasing the heart’s workload and potentially leading to heart failure.

Coronary Artery Disease (CAD): Although rare in younger women, CAD can cause heart failure during pregnancy, especially with risk factors like obesity or diabetes.

Anemia: Severe anemia reduces oxygen delivery, forcing the heart to compensate, possibly resulting in heart failure.

Arrhythmias: Irregular heart rhythms can impair the heart’s pumping efficiency, leading to heart failure.

Identifying the signs of heart failure in pregnancy can be challenging, as some mimic regular pregnancy changes. However, persistent or severe manifestations warrant medical attention:

Shortness of Breath: Difficulty breathing, especially when lying flat or during minimal exertion.

Swelling (Edema): Excessive swelling in the ankles, feet, legs, or abdomen beyond typical pregnancy-related edema.

Fatigue: Unusual tiredness that interferes with daily activities.

Rapid or Irregular Heartbeat: Palpitations or sensations of a racing heart.

Chest Pain: Discomfort or pain in the chest area.

Persistent Cough: A cough producing pink, frothy mucus.

Sudden Weight Gain: Rapid weight increase due to fluid retention.

Diagnosing heart failure during pregnancy requires a careful approach to protect both mother and fetus:

Clinical Evaluation: A thorough assessment of medical history and physical examination to identify signs of heart failure.

Blood Tests: Evaluations to detect markers indicating heart stress or damage.

Electrocardiogram (ECG): A test to assess the heart’s electrical activity and identify rhythm disturbances.

Echocardiogram: An ultrasound imaging to evaluate heart structure and function.

Chest X-ray: Used cautiously to detect heart enlargement or fluid accumulation in the lungs.

Cardiac MRI: Employed selectively to provide detailed heart images without radiation exposure.

Prompt and accurate diagnosis is vital for effective management and improved outcomes.

Managing heart failure during pregnancy involves a multidisciplinary approach. Close monitoring and management by a cardiologist specializing in pregnancy is crucial throughout treatment.

Key points about heart failure treatment during pregnancy:

Safe medications:

• Beta-blockers: Considered the first line of treatment, they can help control heart rate and rhythm but may need dose adjustments during pregnancy.
• Diuretics: Used to manage fluid retention, but careful monitoring is necessary to avoid excessive diuresis and potential complications like oligohydramnios.
• Digoxin: This drug may be used in some cases to improve heart muscle contractility, but careful monitoring of serum levels is required.
• Hydralazine and nitrates: Can be used as vasodilators to reduce afterload in specific situations.

Medications to avoid:

• ACE inhibitors: Can cause serious fetal developmental issues and are strictly contraindicated during pregnancy.
• Angiotensin receptor blockers (ARBs): Also considered teratogenic and should not be used during pregnancy.

Management strategies:

• Strict monitoring: Regular monitoring of heart function, blood pressure, fetal well-being, and electrolyte levels is vital.
• Dietary modifications: Low sodium diet to manage fluid retention.
• Fluid management: Careful monitoring of fluid intake and output to prevent fluid overload.
• Delivery planning: Depending on the severity of heart failure, the delivery plan may need to be adjusted, including potential early delivery or cesarean section.
• Postpartum Care: Continued monitoring and rehabilitation for mothers recovering from pregnancy-related heart failure.

Preventing heart failure during pregnancy is possible by managing pre-existing conditions and adopting a heart-healthy lifestyle:

• Preconception Cardiac Evaluation: Women with known heart conditions should undergo a thorough assessment before conception.
• Regular Prenatal Check-ups: Monitoring blood pressure, weight, and heart function throughout pregnancy.
• Healthy Diet: A balanced diet rich in essential nutrients supports overall heart health.
• Controlled Physical Activity: Moderate exercise, as advised by a healthcare professional, benefits cardiovascular health.
• Avoiding Alcohol and Smoking: These habits increase the risk of heart complications.

Heart failure during pregnancy is a serious but manageable condition. Early diagnosis, appropriate medical intervention, and lifestyle modifications can significantly improve maternal and fetal outcomes. Dr. Vishal Khullar, a distinguished cardiovascular surgeon in India, strictly advises the following important considerations:

• Consult a cardiologist: Any woman with heart failure during pregnancy should be managed by a cardiologist with expertise in managing pregnant patients.
• Individualized treatment: The specific treatment plan will depend on the severity of heart failure, underlying cause, and gestational stage.
• Potential complications: Heart failure during pregnancy can increase the risk of complications like preterm labor, low birth weight, and maternal complications.

Reference Links:

https://www.pennmedicine.org/for-patients-and-visitors/patient-information/conditions-treated-a-to-z/peripartum-cardiomyopathy#

https://my.clevelandclinic.org/health/diseases/17068-heart-disease–pregnancy

Disclaimer: The information shared in this content is for educational purposes only and not for promotional use.