HEALTH : Pregnancy and heart diseases

Pregnancy is a state of altered physiology of a woman. Many women are healthy otherwise, but after becoming pregnant any latent disease may be precipitated or existing disease may be aggravated thus making them sick. Diseases of the heart can also occur or become aggravated during pregnancy causing much suffering to the mother and risk to the baby. Normally during pregnancy, cardiac output is increased, thus increasing the body blood volume, blood pressure and pulse rate. This can produce an abnormal sound on examination, which may mislead one to think of heart disease. A pregnant woman suffers from breathlessness on exertion, palpitations, and swollen feet in advanced pregnancy, features which mimic heart disease. These are natural changes which disappear 4 to 6 weeks after delivery. But one has to be very careful to see that actual heart disease is not masked or ignored, by considering these symptoms to be natural. In case of some women having chronic hypertension, it can be accentuated during pregnancy. Some women develop hypertension after 4 to 5 weeks of pregnancy, which may revert to normal after delivery. But while it is present, it can lead to pre eclampsia and eclampsia of pregnancy, which can be fatal for both the mother and child. If a lady has some mild damage to the heart valves, heart failure can be precipitated during pregnancy. While those having symptomatic valve lesions, will suffer from augmentation of symptoms. Ischemic heart disease like angina is also aggravated during pregnancy. Some women have congenital heart disease (present since birth). If the congenital defect is mild like a small defect in the septum separating the chambers of the heart (ASD or VSD), the affected woman can carry on the pregnancy smoothly. But in case of large defects, the patient gets bad to worse as the pregnancy advances. Any type of cardiac problem causes suffering to the expectant mother. It gets difficult for her to walk even few steps. Rest also becomes difficult because breathlessness increases on lying down. If there is a very high blood pressure, or a severe cardiac problem, the mother can die. The baby is also at risk if the mother has a heart problem. Blood supply to the baby is reduced which can lead to intrauterine growth retardation, premature delivery or even death. Use of alcohol and tobacco tends to aggravate the cardiac problem. Similarly uncontrolled diabetes, high blood lipid levels are also risk factors for precipitating cardiac problems in pregnancy. Medicines taken for hypertension and cardiac troubles can pose problems for the mother and baby. Drugs used for hypertension like beta blockers, tend to cause slow heart rate and low blood glucose in the baby and also reduce perfusion to the baby. They also prolong labor. Diuretics reduce perfusion to the baby. Digoxin one of the most commonly used drugs for cardiac failure tends to lead to low birth weight and premature babies. Aspirin and heparin have the potential to cause hemorrhage in the expectant mother. Nitrates used for angina lead to low blood pressure in the mother and fetal growth retardation. In fact no drug is absolutely safe for a pregnant woman. But irony is that left untreated, the heart problem can be fatal for both the mother and the baby. Therefore, somebody having a cardiac problem should be careful enough to avoid pregnancy. If having a baby is a must, then a doctor should be consulted at the earliest, regarding the drugs to be taken. If symptoms suggestive of heart disease develop during pregnancy, the problem should be confirmed by electrocardiography and cardiac echo. Adequate rest, avoidance of heavy physical work, avoidance of alcohol, and good nutritious diet helps to pull the patient safely over the 9 months. As per the doctor’s discretion, planned caesarean section is done at full term for the safety of both mother and the child. Where necessary, some safe surgical intervention is done to help the ailing woman. Use of contraceptives after child birth, would be prudent to avoid another pregnancy and the hassles associated with managing the cardiac problem with pregnancy. rachna212002@yahoo.co.uk