Matters of the heart continued...

Many people don’t know what palpitations are…

Some common words or phrases I hear are:-

‘My heart goes very fast and then stops suddenly..’

‘My heart races…’

‘I can hear my heart thumping and pounding in my chest…’

‘I feel butterflies in my chest…’

What's normal?

The RESTING heart rate in a healthy human being is between 60-100 beats per minute (bpm). Anything above 100bpm, while RESTING is too fast and anything below 50 bpm is too slow. This is broadly speaking here and there are some individuals who have very slow heart rates but are completely asymptomatic and healthy with it.

In pregnancy, our body is adapting not only to meeting our daily requirements, but also to growing a new life! As a result, the increased demand means our hearts pump faster and stronger. You can expect your heart rate to increase by approximately 25% during pregnancy. The signs of an increased circulation are slightly warmer hands and feet, with sometimes a faint red circle over the palm. You may also feel your heart racing at times (palpitations).

Whilst at work, I am often called to see pregnant ladies who have resting heart rates persistently above 110bpm. After excluding any obvious causes for this such as infection, electrolyte disturbance, clots within the body and thyroid dysfunction, this heart rate is often normal for them.

I always reassure ladies who are in this position that they are still healthy and the feeling that their heart is racing at times is normal as long as they feel well with it…and that’s the important thing. There should be no fainting, dizzy spells or chest pain along with it.

Anxiety/Panic Disorder

Anxiety can manifest in a number of ways and during pregnancy, women experience a variety of symptoms that may be a sign of anxiety. Feeling their heart is racing along with chest pain and shortness of breath are the common signs and symptoms. People often describe a sheer fear that something is going to happen to them. It is similar to the ‘fight or flight’ response. It doesn’t necessarily happen in a particular situation. It can happen at any time of the day and for no obvious reason.

If you experience this, it is best to go and see your doctor to rule out anything else that may be the cause. I usually advise a blood test to check all electrolytes, thyroid tests and a 24hr monitor of your heart rhythm to ensure there is no abnormal heart rhythm causing these symptoms. If all is clear and you are informed you have anxiety, there are several ways to treat this. Cognitive Behavioural Therapy is one way to address the problem. This method trains your mind into dealing with the symptoms when they occur while maintaining control. Some people who experience regular palpitations take Propranolol, a drug that reduces your heart rate.

The problem may fix itself once the baby is born but not all the time.

Arrhythmia – abnormal heart rhythm

Arrhythmia just means abnormal rhythm.

Our hearts have an in built natural pacemaker, which ensures that they beat regularly and in synchrony.

Arrhythmias are far less common in pregnancy and if they occur, will occur in the individual who already has a known structural heart problem.

As mentioned before, many signs are heightened during pregnancy and ladies may be more aware of extra beats or a faster heartbeat; but if there is no other associating symptom (more concerningly fainting), then this is usually normal.

The most common arrhythmia in pregnancy is extra beats or ectopic beats. As the heart is pumping faster and stronger and the chambers of the heart stretch, some people become aware of extra beats. This is normal and occurs very commonly and more often than you think. 24-hour heart rhythm recordings usually confirm this and do not require any treatment. If however, you are feeling very symptomatic with it, drugs can be prescribed to reduce your heart rate and subsequently, reduce the incidence of extra beats.

Other arrhythmias include atrial fibrillation, supraventricular tachycardia and ventricular tachycardia. Without getting into the nitty gritty (and without scaring all my readers!!!), it is uncommon for any of these to arise in pregnancy and usually occurs in people who already suffer with any of the above.

It is always best to go to your GP who can arrange a 24-hour monitor of your heart rhythm. This should pick up any abnormality. If your symptoms don’t occur frequent enough there is a chance that the 24 hour monitor will jot highlight anything and in these circumstances, a 7 day monitor can be placed on you to rule out anything sinister.

As a general rule of thumb, if you are experiencing fast heart rates and are feeling dizzy or chest pain with it, go to see your doctor. If you have blacked out at all with it, you need to seek urgent attention and get this addressed. I say this because your blood volume increases during pregnancy but also during labour, there is a surge of hormones and changes in blood volume ,which can trigger an arrhythmia. This may complicate your health or your baby’s health so it is better to see someone sooner.

If you are diagnosed with an arrhythmia, most often you will be treated with drugs to slow down your heart rate and minimise the chances of causing any harm to the baby. If drugs do not work, there are minor operations that are available to address the problem. If it gets to this point, you will no doubt be under the care of a cardiologist who specialises in this field.

If you have an arrhythmia, this DOES NOT mean your baby will also acquire it.

Peripartum Cardiomyopathy – weak heart muscle

Palpitations can also occur as a result of cardiomyopathy. Cardiomyopathy is a disease of the heart muscle itself leading to symptoms of heart failure. It can occur during the latter stages of pregnancy up to 6 months postpartum.

Symptoms are not just limited to palpitations (to be honest, palpitations are the least of your worries if you have this condition) but there is shortness of breath, swelling with fluid retention in ankles and legs, fluid in the lungs, inability to sleep flat due to shortness of breath and reduced exercise tolerance. Palpitations result as a consequence of the heart not being able to maintain a normal rhythm in these circumstances.

This condition is pretty serious and you will most likely be hospitalised and precautions will be taken to ensure that you and baby are safe during the pregnancy and delivery. Treatment includes medications to help strengthen the heart, if things get very serious, heart transplantation is a last resort. If women experience this while pregnant, there is a much higher chance, they will also experience this with subsequent pregnancies.

Again, you will be under the care of both an Obstetrician and a cardiologist who specialises in this field.

The consequences to your baby as a result of peripartum cardiomyopathy may be poor organ development and growth restriction.

Hyperthyroidism – overactive thyroid

An overactive thyroid can lead to palpitations and arrhythmias. If you are known to have thyroid problems before concieving, doctors usually ensure they take blood tests to check the level of your thyroid hormones during pregnancy. If you have an overactive thyroid, you will be put onto medication in order to normalise the levels.

Other symptoms of an overactive thyroid include, feeling very hot, loose stool, hand tremors, fatigue and muscle weakness.

This problem is unlikely to START in pregnancy so I advise people who already have thyroid problems to have their levels checked when they are pregnant. It is important to stay on top of this as hyperthyroidism can result in stillbirths, prematurity, congenital malformations and fast heart rates in the foetus.

These are the most common causes of palpitations during pregnancy and the postpartum period. I hope this helps but I also want to reassure you that palpitations are also a very normal symptom. Some people have extra heart beats and are never aware of them, others feel it all the time and want to do something about them. Medications and procedures to treat these ectopic beats get a little more complicated when pregnant as some drugs can be harmful to the foetus so are best avoided if at all possible. As long as you do not get associated fainting or chest pain, they usually are something that should disappear after pregnancy.

Again, I wish you all a healthy pregnancy!!!

Speak soon

MCD

xxx