Heart conditions during pregnancy

When you’re pregnant, your cardiovascular system works a little harder than normal to pump more blood throughout your body. This increased stress means than certain heart conditions, called cardio-obstetric conditions, can happen or get worse during pregnancy. These conditions come with possible risks for both you and your baby.

What are cardio-obstetric conditions?

It’s important for expecting parents to understand cardio-obstetric conditions so that they get the right care when they need it. Heart conditions that can affect your pregnancy include:

• Gestational hypertension, preeclampsia, and eclampsia
• Heart rhythm disorders
• Peripartum cardiomyopathy (PPCM)
• Congenital heart disease
• Prior heart attack or prior heart disease diagnosis

Gestational hypertension, preeclampsia, and eclampsia

This group of cardio-obstetric conditions is related to your blood pressure.

• Gestational hypertension (high blood pressure during pregnancy) happens when you have a blood pressure measurement higher than 140/90 mmHg without protein in your urine or other signs of organ damage. Once diagnosed, there’s a 1 in 4 chance that this condition will develop into preeclampsia.
• Preeclampsia is a condition specific to pregnancy where you have gestational hypertension and protein in your urine (proteinuria). It usually happens after 20 weeks of pregnancy but can also happen right after giving birth.
• Eclampsia is a more severe form of preeclampsia that causes seizures.

Both preeclampsia and eclampsia are very serious conditions with major risks to you and your baby’s well-being.

Symptoms of pregnancy-related hypertension and preeclampsia

Talk to your OB-GYN, midwife, or maternal-fetal medicine specialist if you notice or experience any of the following symptoms:

• Sudden weight gain
• Vision changes like blurry vision, light sensitivity, or seeing spots
• Excessive nausea and vomiting beyond typical morning sickness 
• Pain in the right side of your upper abdomen
• Decreased urination
• Seizures

Sometimes, gestational hypertension and preeclampsia don’t have any noticeable symptoms until after you have a high blood pressure reading at one of your prenatal checkups.

Screening and diagnosis

Gestational hypertension and preeclampsia are usually diagnosed at a regular prenatal checkup, after you have a high blood pressure reading or a urine test that’s positive for proteinuria.

After you are diagnosed, you may have further blood testing to check your liver and kidney function, as well as an ultrasound to look at your baby’s growth and how your placenta is functioning. These tests can help confirm how severe your condition is and guide next steps in your treatment.

Treatment options

Once you’re diagnosed with preeclampsia, your OB-GYN, midwife, or maternal-fetal medicine specialist will refer you to a women’s heart health specialist for more specialized care.

Our doctors will monitor your blood pressure regularly throughout your pregnancy as well as after you give birth. Treatment may include medication to lower your blood pressure and prevent seizures. You may also need to deliver your baby earlier than 40 weeks to help relieve symptoms.

After being diagnosed with preeclampsia during pregnancy, you have a higher chance of developing high blood pressure later in life and in future pregnancies. You may also be more at risk for experiencing heart problems at a younger age.

Learn how to schedule an appointment with an AHN women’s heart health specialist.

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Heart rhythm disorders during pregnancy

Heart rhythm disorders, also known as arrhythmias, range from occasional palpitations to life-threatening conditions. The extra stress on your heart during pregnancy can trigger new arrhythmias or make existing ones worse.

There are many types of arrythmias that can happen during pregnancy, including atrial fibrillation, supraventricular tachycardia, and ventricular tachycardia.

Symptoms

If you have a heart rhythm disorder, you may experience:

• Palpitations. These feel like your heart is racing, fluttering, or pounding.
• Dizziness or lightheadedness. This is caused by reduced blood flow to the brain when your heart beats irregularly.
• Fainting. When your heartbeat is very irregular, you may lose consciousness.
• Shortness of breath. Inefficient blood circulation can make it harder for you to breathe.
• Chest pain. Although not as common, some arrhythmias do cause chest pain.

Screening and diagnosis

Diagnosing heart rhythm disorders usually starts with a physical exam and reviewing your symptoms in detail. This includes testing with an electrocardiogram (ECG) to look at your heart’s electrical activity and identify the type of arrhythmia. Other tests, like a Holter monitor (continuous ECG), echocardiogram (heart ultrasound), and sometimes cardiac catheterization may be needed.

Treatment for heart rhythm disorders

Getting treatment for arrhythmia during pregnancy depends on the type of arrhythmia and your symptoms. Your options include:

• Medication to help regulate your heart rhythm
• Cardioversion (restoring normal heart rhythm through electrical shock)
• Cardiac ablation (removing abnormal heart tissue)

In severe cases, early delivery may be an option to reduce your overall risk of complications.

Learn how to schedule an appointment with an AHN women’s heart health specialist.

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Peripartum cardiomyopathy (PPCM)

This rare but serious condition weakens your heart muscle, leading to heart failure during pregnancy or after you give birth. It usually develops toward the end of pregnancy or within five months after delivery and can range from mild to severe.

PPCM symptoms

If you have peripartum cardiomyopathy, you may notice:

• Shortness of breath or difficulty breathing, especially when working hard but also at rest
• Extreme tiredness and weakness
• Swelling in the legs, ankles, and feet due to the heart not pumping blood correctly
• Rapid heartbeat to overcompensate for a weakened heart
• Persistent cough, sometimes with frothy mucus that means you have fluid in your lungs

Screening and diagnosis

Peripartum cardiomyopathy is diagnosed with a physical exam, ECG, heart ultrasound, and blood tests.

Treatment for PPCM

Once you have been diagnosed with PPCM, we’ll focus on supporting your heart and managing your symptoms. This usually involves prescribing medications like:

• Angiotensin-converting enzyme (ACE) inhibitors to help relax your veins and arteries and lower blood pressure
• Beta blockers that cause the heart to beat more slowly and with less force, as well as widen veins and arteries to help improve blood flow
• Diuretics to help reduce fluid buildup in the body

In more serious cases, you may need more advanced treatments like mechanical support for your heart or even a heart transplant. Throughout your pregnancy and after delivery, we’ll closely monitor your heart and baby’s health.

PPCM care during pregnancy and delivery

A team of specialists, including your OB-GYN, a maternal-fetal medicine specialist, cardio-obstetrics specialists, and advanced heart failure specialists, will manage your care throughout your pregnancy.

This team will work together to create a personalized treatment plan to monitor your heart function with regular ultrasounds of your heart, your blood pressure, and your heart rate throughout your pregnancy. We’ll carefully choose medications that are safe for you and your baby during pregnancy and for breastfeeding.

Before delivery, our team will meet with an anesthesiologist to make sure everyone is on the same page to get the best possible outcome for both you and your baby.

If at any point you need more intensive care, our cardiac intensive care unit (ICU) provides support for critically ill pregnant women.

PPCM care after delivery

Once your baby is born, you’ll have frequent follow-up appointments to adjust your medications and see how you’re recovering. 

Learn how to schedule an appointment with an AHN women’s heart health specialist.

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Congenital heart disease during pregnancy

Some women have congenital heart disease (CHD) that goes undiagnosed until they become pregnant. CHD means your heart has a problem that has been there since birth. There are many types of congenital heart disease that vary in severity and how they impact your pregnancy.

Congenital heart disease symptoms

The symptoms of CHD can vary widely depending on the type of CHD and how severe it is. You may not experience any symptoms at all, or you may experience shortness of breath, heart palpitations, chest pain, or fatigue.

Screening and diagnosis

A prenatal echocardiogram (heart ultrasound) may detect congenital heart disease. However, CHD is often discovered during pregnancy after routine testing or when symptoms develop.

CHD treatment options in pregnancy

If you have been diagnosed with congenital heart disease during pregnancy, you will need careful management of your condition because it can affect both you and your baby. Your treatment depends on the specific type and severity of your condition and may include medication or surgery.

A multidisciplinary team, including your OB-GYN, a cardio-obstetrics specialist, an adult congenital heart disease specialist, a maternal-fetal medicine specialist, and an anesthesiologist, will work together on your care. We will closely monitor you throughout your pregnancy with regular check-ups and tests like heart ultrasounds.

We’ll also regularly discuss your care in team meetings, including a monthly cardio-obstetrics conference and a pre-delivery planning session. This makes sure that everyone is on the same page to provide the best possible care for you and your baby.

Learn how to schedule an appointment with an AHN women’s heart health specialist.

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Previous heart attacks or a heart disease diagnosis and pregnancy

If you have a history of heart attacks or have been diagnosed with heart disease, you face increased risks during pregnancy. We offer preconception counseling to help you understand the severity of these risks, which depend on how damaged your heart is.

Symptoms

During your pregnancy, you may experience symptoms that feel similar to those of a previous heart attack, including:

• Uncomfortable pressure, squeezing, fullness, or pain in the center of your chest that lasts more than a few minutes or goes away and comes back
• Pain or discomfort in your back, neck, jaw, stomach, or arms
• Shortness of breath with or without chest pain or discomfort
• Dizziness or lightheadedness
• Nausea
• Breaking out in a cold sweat
• Unusual tiredness or weakness

These symptoms may be worse than you previously experienced because of the physiological changes during pregnancy like increased blood volume and how hard your heart is working.

Screening and diagnosis

Throughout your pregnancy, you’ll need extensive cardiac evaluation and monitoring. This includes tests like ECG, echocardiogram, and cardiac stress tests to look at your heart’s function and identify potential risks.

Treatment options

We’ll monitor your heart closely, adjust your medications as needed, and work closely with your OB-GYN to keep you and your baby healthy. If you already see a cardiologist, they will work with our cardio-obstetrics specialist and your OB-GYN to provide the best possible care during pregnancy.

Learn how to schedule an appointment with an AHN women’s heart health specialist.

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Why choose AHN for cardio-obstetric care during pregnancy?

If you develop gestational hypertension, preeclampsia, eclampsia, or even a rare issue like peripartum cardiomyopathy during your pregnancy, the AHN Women’s Heart Center and Cardio-Obstetrics Clinic offers the specialized care you need.

Our team of cardiologists and maternal-fetal medicine specialists use advanced technology and evidence-based approaches to provide coordinated care, making sure that your health and your baby’s well-being are a top priority. We believe shared decision-making is extremely important and always take your wishes and preference into account when determining your care plan and treatment.

If you’re pregnant or planning to become pregnant and you have a heart condition, learn more about the specialized care you’ll receive at the AHN Cardio-Obstetrics Clinic and schedule your appointment today.

Learn how to schedule an appointment with an AHN women’s heart health specialist.

Schedule an appointment

If you’re pregnant or planning to become pregnant and you have a preexisting heart condition, the AHN cardio-obstetrics team will help you achieve a healthy pregnancy. If you have been diagnosed with preeclampsia or other pregnancy-related heart condition, we’ll provide specialized care during your pregnancy and after delivery.

Care for preexisting heart conditions

If you’re already seeing a cardiologist for an existing heart condition, your provider will help you manage your care during pregnancy and coordinate with a cardio-obstetric specialist as needed.

Care for preeclampsia or other pregnancy-related heart conditions

If you aren’t already seeing a cardiologist, you can schedule an appointment with an AHN women’s heart specialist by calling (412) DOCTORS 412-362-8677. When scheduling your appointment, mention your pregnancy and condition or diagnosis. Your current provider can also provide a referral and help you schedule your appointment as soon as possible.

Care locations

The AHN Cardio-Obstetrics Clinic offers in-person appointments at our main location in Pittsburgh:

We also offer appointments at our other locations:

Virtual appointments

To make things easier and more convenient for you, we offer telehealth appointments. Scheduling a virtual visit may get you a faster appointment when you’re first diagnosed.

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