29 September 2011
By , Umesh Isalkar
Pune , India
Palpitation, Murmurs Must Be Taken Seriously For The Safety Of Mother And Baby
When Anita (30) was six months into her pregnancy, she developed breathlessness and palpitation. Her family members comforted her saying that such signs brought on by fatigue were normal in her condition.
An increase in the blood’s volume during pregnancy can make patients with borderline heart defects realise abnormalities which have hitherto remained unknown. Such accidental diagnosis of heart disease is seen in 2 to 3 patients in 100 pregnancies.
A regular medical check up is essential to rule out common conditions like heart valve problem, hole in the heart, pregnancy induced hypertension and pulmonary (lung related) hypertension during pregnancy, say experts.
“Sudden breathlessness, breathlessness after sleeping, irregular heart beats and bluish colouration of the nails during pregnancy should be immediately investigated by a physician. These symptoms could be pointers to valve dysfunction, hole in the heart, pregnancy induced hypertension and pulmonary (lung related) hypertension. If unattended, patients may have sudden heart failure, develop infection and serious problems during pregnancy,” said cardiac surgeon Chandrashekhar Kulkarni.
Increase in blood flow during pregnancy starts from the fourth month and peaks at around eight months of gestation. Symptoms start showing from the fourth month of pregnancy and increase in severity till the eighth month, he added.
If the patient’s valves are not working properly, she might have trouble tolerating the increased blood flow. In addition, abnormal valves carry an increased risk of endocarditis — a potentially life-threatening infection of the lining of the heart and heart valves and could lead to problems during delivery, he said.
Kulkarni said, “Oxygen supply to the foetus depends on the maternal circulation of blood. Any interference with proper blood circulation may even lead to preterm labour, miscarriage and brain damage of the foetus due to hypoxia -- less oxygen in foetus’s blood.”
“Once any of these borderline defects become serious enough, adequate treatment in the form of balloon dilatation, closure of the holes can be taken up safely up to six months of pregnancy with good success rate. Any intervention beyond six months of pregnancy carries higher risk to the mother and foetus,” Kulkarni said.
Normally, heart diseases in pregnancy are seen at the rate of one or two cases per 100 pregnancies. Early diagnosis, proper treatment and delivery in hospitals are mandatory for a good outcome. Post-pregnancy, the symptoms usually reduce significantly and the risk of subsequent heart failure is almost that of the general population.
Interventional cardiologist Rahul Patil said that all women pregnant for the first time have symptoms like breathlessness palpitation between three and six months of pregnancy. The physiological causes are usually increased blood volume, decreased haemoglobin and shift of diaphragm because of a bulky uterus. Hence, assessing whether the patients has heart disease is very difficult.
“However, a good and thorough clinical examination of the chest can diagnose heart disease by assessing heart sound and a peculiar sound of blood flow called murmur. The only investigation to confirm heart disease is 2D echocardiography and colour doppler. These tests not only diagnose, but also help assess the severity and how the patient will do during the last months of pregnancy and at the time of delivery. The decision of surgery before delivery or after delivery is also made at this stage,” Patil said.
According to Patil, the incidence of accidental diagnosis during pregnancy is three to five cases in 100 pregnancies. “A 22-year-old pregnant woman developed breathlessness and palpitation from six months of pregnancy. Her gynaecologist suspected the problem and asked her to go for 2D echocardiography which underlined the problem.Gynaecologists play a crucial role in diagnosing heart disease during pregnancy,” Patil said.
The patient had severe mitral stenosis (narrowing of the valve). If it had remained undiagnosed, the risk of heart failure and death during delivery was extremely high. “She underwent mitral valve dilatation in the seventh month of her term, and later delivered a normal baby, without complications. The procedure of balloon dilatation is done from the groin without general anesthesia, without any stitches and with a hospital stay of two days and complication rate of less than .5 % in experienced hands,” Patil said.
At the time of delivery, antibiotics advised by cardiologists are administered by the gynaecologist to prevent valve infection, he added.
“Such cases go undetected in rural areas as antenatal care is virtually absent in villages. Whereas in an urban set up, the incidence of valvular heart disease is around 2% in which mitral valve disease predominates,” said senior cardiologist Abhijit Vaidya.
“Breathless and palpitation are common symptoms seen in any pregnancy. During routine antenatal check up, it is important for gynaecologists and general practitioners to listen to the heart sounds and detect abnormality like a murmur. Further evaluation is necessary to rule out the presence of valvular heart disease. Diagnosis of heart disease during pregnancy is important to avoid serious complications during delivery and immediately after delivery,” said senior gynaecologist Charuchandra Joshi, president of the Pune Obstetrics and Gynaecological Society (POGS).
Did You Know?
t Men and women differ by just one chromosome out of 46 and yet it has made a world of difference in its impact on health and disease
t Until recently, women were thought to be the protected gender, due to their hormone - estrogen, with its protective effect. But recent data, culled from the American Heart Association, reveals that since two decades, every year globally, more women die of cardiovascular diseases than all other causes of death combined together
t By 2015, coronary artery disease will cause 32 per cent of all female deaths in India. Middle and lower middle-class females are at high risk. They will comprise 80 to 85 per cent of female population suffering from coronary artery disease (CAD). Cardiac preventive screening in women is uncommon
t Recently, the incidence of CAD has increased in pre-menopausal females, the reason being urbanisation. Interestingly, it is more in South Indian females (45.3 per cent) than North Indian females, as the former have a larger number of passive smokers t The recent increasing trend in heart diseases in women is due to (a) more sedentary habits (b) increasing prevalence of obesity and diabetes (c) smoking and depression which gets further amplified when combined with oral contraceptive pills and (d) ever-increasing stress! The added risk of concomitant diabetes nullifies the protective estrogen benefit t Heart valve diseases are still prevalent in India and pose great burden on both mother and foetus, but good medical care can reduce the risk. Yet another problem after delivery is a grave condition called peripartum cardiomyopathy, where heart pumping weakens to fatal low levels. In 33 per cent cases, it may normalise in a year but can recur with further pregnancies and hence subsequent pregnancies must be avoided
Take Care
t Preventive treatment works equal in both genders, but studies have shown that women are less aware about cardiac risk factors t Diet is the most important preventive measure, as you can control your cholesterol, blood sugar and high blood pressure t Go for a low-salt, low-fat, high-fibre, complex carb diet. It should have a daily intake of 400 grams of fruits and vegetables.
Fruits, particularly papaya and apple, and/or any of the citrous kind, are heart-friendly. Include tomatoes and carrots t A daily intake of 10 grams of garlic, eaten raw, is also beneficial. Ditto with five almonds per day. Sunflower, mustard, soyabean or ricebran oil is preferred and the daily intake should not be more than 25 ml t Fried food, especially available in packets like chips and wafers, coconut oil, ghee and butter, should be avoided t Also avoid tobacco in any form t Regular exercise, brisk walking for at least 45 minutes in the morning and if possible in the evening is a must t Manage stress with the help of stress-busters. From reading a book to listening to your genre of music to watching a movie
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