Introduction:
One of the main causes of problems during pregnancy is cardiovascular disease. In the United States, the most prevalent cardiac condition affecting pregnancies is congenital heart disease. However, the most severe side effects are brought on by cardiomyopathy. High blood pressure is one of the disorders that pregnancy may potentially cause. According to reports, between 1 and 4 percent of pregnancies result in heart illness, which is a major source of morbidity and mortality. Even though there is a considerable risk associated with these pregnancies, most of these instances can be effectively treated, provided regular treatment includes early identification and appropriate follow-up.
What Are Pregnancy-Related Heart Diseases?
Heart issues that arise during pregnancy are referred to as gestational heart disease. Two primary categories of cardiac issues might arise during pregnancy:
- Heart Problems That Existed Beforehand: These are heart conditions that the women had before getting pregnant. These illnesses may not have previously shown any signs or serious side effects. However, they can have various effects on women and cause difficulties during pregnancy.
- Heart Disorders That Emerge During Gestation: Before becoming pregnant, women did not have any of these conditions. While some are safe, others could be hazardous.
The majority of women with cardiac conditions can conceive and give birth to healthy children. However, heart problems can occasionally result in major issues when pregnant. It is the primary cause of mortality among expectant mothers in the United States.
What Is the Etiology Behind Heart Disease in Pregnancy?
Depending on the underlying pathology, the etiology of cardiovascular disorders during pregnancy varies.
Pregnancy-related cardiovascular disorders are outlined below, along with some theories on their possible causes:
1. Cardiomyopathy:
Regarding the etiology of this illness process, there are several theories. The most popular explanations include hemodynamic instability, autoimmune reasons, microchimerism, viral myocarditis, etc. It is crucial to remember that the risk factors for cardiomyopathy that are present in non-pregnant people persist throughout pregnancy and the weeks that follow, and the heart may even be more vulnerable to these exposures. These include abusing narcotics like cocaine and methamphetamines, abusing alcohol, and abusing doxorubicin.
2. Heart Disease:
Pregnant women and non-pregnant women share a similar etiology for ischemic heart disease. These people are susceptible to ischemic heart disease due to several risk factors, such as diabetes mellitus, obesity, smoking, immobility, hypertension, hyperlipidemia, and hypertriglyceridemia.
3. Chronic Myocardial Infarction Linked to Pregnancy:
There are similar risk factors for pregnancy-related MI as there are for coronary artery disease. Preeclampsia and eclampsia are two pregnancy disorders that have been linked to myocardial infarction, according to theory.
4. Disorders of The Valves:
Pregnancy may play a special role in the etiology of newly identified valve illnesses, even though the hemodynamics of pregnancy may make some valvular conditions worse.
What Are the Changes to the Heart and Blood Vessels Occurs During Gestational Period?
A pregnant woman's body goes through a lot of changes. The body experiences additional stress due to these alterations, increasing heart rate. During pregnancy, the following changes are usual. They facilitate adequate oxygen and nutrition delivery to the developing fetus.
Rise in Blood Volume:
The initial weeks of pregnancy cause an increase in blood volume, which persists thereafter. Pregnancy typically causes a total blood volume rise of between 40 and 45 percent in most women.
Elevation in Heart Rate:
During pregnancy, an increase in heart rate of 10 to 20 beats per minute is typical. It steadily increases during pregnancy, reaching its peak by the third trimester.
Rise in Heart Output:
A heart's cardiac output is the volume of blood it pumps out in a minute. There might be a 30 percent to 50 percent increase in cardiac output by weeks 28 to 34. This results from a quicker heart rate and increased blood volume. The heart rate might rise by as much as 60 percent in pregnant women carrying twins.
These alterations might make women feel:
- Overly exhausted (fatigued).
- Lightheaded or dizzy.
- Breathlessness (dyspnea).
- Palpitations, or the feeling of a rapid heartbeat.
What Is the Pathophysiology of Heart Disease in Pregnancy?
While moderate heart disease may initially manifest during pregnancy, pregnancy affects the cardiovascular system and frequently exacerbates pre-existing heart disease. Increased blood volume, stroke volume, and heart rate are stressors leading to lower hemoglobin levels. Cardiac output rises by 30 percent to 50 percent. During weeks 28 and 34 of gestation, these changes reach their peak.
The second stage of labor is characterized by straining and an increase in venous blood returning to the heart from the contracting uterus. During labor, cardiac output increases by around 20 percent with each uterine contraction. A few weeks following birth, cardiovascular stresses recover to pre-pregnancy levels.
What Heart Problems Could Develop During Pregnancy?
Numerous heart and blood vascular issues can arise during pregnancy.
1. High Blood Pressure
Up to 10 percent of expectant mothers experience high blood pressure, and the frequency of it is rising. The growth is more pronounced among black individuals than among White individuals.
The following is a diagnosis of high blood pressure:
Gestational Hypertension - After week 20, a woman may develop gestational hypertension, which is defined as high blood pressure (at least 140/90 mm HG).
Preeclampsia - Starting after week 20, this condition is known as preeclampsia. It also manifests as signs of organ damage or as protein in the urine (pee). When seizures accompany preeclampsia during pregnancy or within ten days of giving birth, the condition is referred to as eclampsia.
Chronic Hypertension - Hypertension that lasts longer than 20 weeks or before conception is known as chronic hypertension.
2. Gestational Diabetes
After week 20 of pregnancy, elevated blood sugar levels are the first signs of gestational diabetes. In the United States, this illness affects around 6 out of every 100 pregnancies. All ethnic backgrounds are susceptible to it. Still, non-Hispanic Asians are the most likely to experience it.
3. Peripartum Cardiomyopathy
A kind of heart failure known as peripartum cardiomyopathy develops towards the end of pregnancy or shortly after childbirth. It impacts those who have never been diagnosed with heart disease before. This illness stops the heart from supplying the body with adequate blood. Although it may happen to anybody at any age, those over 30 are often affected.
4. Pulmonary Embolisms and Deep Vein Thrombosis
The risk of pulmonary embolism and deep vein thrombosis (DVT) is increased during pregnancy. Pregnant individuals are four to five times more likely than non-pregnant individuals to have these illnesses. Usually, the time occurs during the postpartum phase, six months after childbirth.
A woman's risk increases if one has already experienced a blood clot or embolism. They will probably need to take a blood thinner for therapy if they have a PE or DVT. They should be prescribed a pregnancy-safe blood thinner by the doctor.
Conclusion:
Each pregnancy needed the collaboration of a team of experts to offer coordinated and efficient care. It is important to inform patients about their cardiac issues early on and allow them to participate in decision-making. It is critical to emphasize the hazards to the patient and the developing fetus. Moms should be counseled about risk factors related to pregnancy-related heart illness from the moment of conception. Pre-existing heart disease, myocarditis, drug and alcohol misuse, diabetes mellitus, hypertension, and familial heart disease are some of these risk factors.
