Heart related diseases are caused by many factors and they are becoming common in pregnant women. The presence of cardiac disease during pregnancy poses a challenging clinical situation to medical doctors because they are also supposed to concentrate on the wellbeing of the unborn baby (Perry etal. 2011). During this time when the mother is pregnant, profound changes occur in the blood circulation, which may adversely affect the health of the mother and that of the unborn baby (Perry etal. 2011). This situation may even get worse if there is presence of underlying heart conditions in the mother. The prevalence of cardiovascular complications among pregnant women has been estimated to be 4 percent, and according to recent research, maternal heart diseases and other heart complications are among the main causes of death in pregnant women. Research has also shown that patients who have undiagnosed heart diseases are likely to have complications or even die during the pregnancy period.
Diagnosis of heart diseases
During pregnancy, there is an increased demand of blood in the body for the mother and unborn child (Sahni, 2012). The increased demand puts a lot of pressure on the heart and circulatory system making pregnant women prone to cardiovascular diseases. The blood demand during pregnancy is 50 percent compared to 30 percent for people who are not expectant (Sahni, 2012). Therefore, the heart has to work extra hard to meet the required demand in the body, which affects the cardiovascular system.
The cardiovascular system is vital because it keeps body organs supplied with oxygen for proper functioning (Sahni, 2012). However, because of some reasons some of the arteries and veins may become impaired making them unable to perform their functions as expected. This impairment leads to cardiovascular diseases, which are different and vary in the way they affect the heart. The impairment can be caused by poor lifestyle, alcohol and tobacco use, obesity, physical inactivity and poor eating habits (Perry etal. 2011). One of the diseases that occur because of cardiovascular system impairment is called coronary heart disease. This condition can be fatal during pregnancy because it causes high blood pressure that causes many maternal deaths.
Diagnosis of heart diseases during pregnancy can be done through checking patient’s medical history, physical examination, and chest examination (Sahni, 2012). Carrying out tests during pregnancy remains the best way to detect a heart disease. In addition, tests can be used to check the general function of the heart (Sahni, 2012). However, it is good to note that x-rays should not be used to get chest films because they can affect the development of the fetus. Nevertheless, an electrocardiogram (ultrasound) is efficient in identifying any irregularities in the heart rate, arrhythmias and detects any past heart problems (Northwestern Memorial Hospital, 2012).
In addition, Cardiac Event Monitors are used on women who have palpitations to determine any abnormality in the heart. The use of Cardiac Monitors enable doctors to check any changes taking place in the heart by monitoring the heart beat in hours or days (Ignarro, Balestrieri, and Napoli, 2007). This helps to detect heart condition, which occurs infrequently and can go undetected if doctors are not keen during this period. Another form of checking the heart during pregnancy is based on ultrasound that has no negative effects on unborn babies (Sahni, 2012). The ultrasound can be combined with a Doppler to determine functioning of the valve throughout the pregnancy period (Northwestern Memorial Hospital, 2012). Other problems that are checked during pregnancy that are associated with the heart include heart infection, blood clots among others. These kinds of problems are only seen through a (TEE) transesophageal echocardiogram (Sahni, 2012). It has been discovered that most heart attacks are a result of blockage in the blood vessels.
Etiology of cardiac disease during pregnancy
Complication of the heart during pregnancy is common and it is therefore, important for pregnant women to understand the risks involved. The pregnancy itself is a source of stress to the heart and the circulatory system (Northwestern Memorial Hospital, 2012). Because of this kind of stress, complications are most likely to occur during this delicate period. Even though, a big number of pregnant women who have heart problems deliver hale and hearty babies. However, in the majority of underdeveloped countries and developing countries, rheumatic disease is one of the major causes of maternal heart diseases (Sahni, 2012).
There are several reasons why cardiac diseases are common in pregnant women. One of the reasons is improved or better health care. Because of better and improved care in the hospitals, women who have heart-related problems are living a healthy life and they survive up to reproductive age (Ignarro, Balestrieri, and Napoli, 2007). It is only during the pregnancy that these complications emerge with full force. The second cause of cardiac disease in pregnant women is changes in demography, which have caused an increase of prevalence in regions with large number of immigrants (Ignarro, Balestrieri, and Napoli, 2007). The third reason why cardiac diseases are common among pregnant women is the tendency to delay motherhood until the third decade (Northwestern Memorial Hospital, 2012). Poor lifestyle, especially unbalanced diet and lack of exercise is another cause of cardiac disease in pregnant women. It has been proved that unbalanced diet may cause obesity, which is a major risk factor for cardiac disease. Other major causes include aortic dissection and myocardial infarction, which makes the heart vulnerable.
Signs, Symptoms, and Causes of the Disease/Disorder
There are different types of heart diseases, which may affect individuals. Pregnant women also suffer a number of heart related problems (Ignarro, Balestrieri, and Napoli, 2007). Current research findings reveal that approximately 90 percent of pregnant women with heart related problems had rheumatic heart disease (Northwestern Memorial Hospital, 2012). The main causes of rheumatic diseases are injuries to the heart and valves, which is brought by rheumatic fever (Northwestern Memorial Hospital, 2012). According to medical experts, rheumatic fever is not a common condition, although it is a serious clinical condition that can cause serious damages. It is caused by bacteria known as streptococcus, which can be treated using antibiotics. Because medical doctors are able to address the problem of rheumatic fever, the percentage of pregnant women with heart disease caused by rheumatic fever is relatively low, especially in the last 10 years (Ignarro, Balestrieri, and Napoli, 2007). Today, the major causes of cardiac diseases among pregnant women are congenital heart conditions and cardiovascular disease. These conditions are more prevalent and are evident in every 1 out of three woman with heart diseases.
There are several symptoms of heart conditions. Some of most common include difficulty in breathing, feeling dizziness and constant chest pains (Northwestern Memorial Hospital, 2012). Other patients may experience dizziness and lightheadedness combined with constant fainting. The presence of these symptoms varies according to level of defects. For instance, less serious congenital heart deficiencies are not easily detected at early stages. In most cases, these defects are only diagnosed at later stages (adulthood). Pregnant women with these defects have symptoms like short breath/ breathing problems, they get tired even after performing simple activities, and they swell in the hands and feet.
On the other hand, a cardiac disease is also another problem experienced by pregnant women. There are varies symptoms that may occur during the pregnancy period; some of the most common include constant fainting, chest pains, shortness of breath, feeling weak (fatigue), having breathing difficulties when sleeping, and constant shivering may also occur. Fainting may occur constantly due to high blood pressure and change of blood volume during the pregnancy. Difficulties in breathing and shortness in breathing may be caused by enlarging uterus as the pregnancy advances (Perry etal. 2011). Palpitations during pregnancy may be caused by change in position of the diaphragm as the fetus grows. Because of change in the blood volume, most pregnant women may develop problems in the heart beat, which can be indentified through cardiac testing (Ignarro, Balestrieri, and Napoli, 2007). Although most women develop swelling of feet and hands during this delicate stage, it is not entirely caused by heart complications (Perry etal. 2011). Because of the fact that heart diseases are many, the doctor should diagnose the patient to know which type of disease his/her patient is suffering from.
Treatment and Prognosis of heart disease among pregnant women
Most heart diseases are easier to treat and manage, especially if they are detected early enough (Perry etal. 2011). Therefore, pregnant women who feel as if they have heart problems, whether judging from the general symptoms and signs; they should consult professionals immediately. In addition to this, it is highly advisable that all expectant mothers should go for regular health check ups during the whole period of pregnancy. In fact, pregnant women are advised to talk to their doctors in regard to any concerns one has about their heart and general health. If a patient does not have an already existing heart condition, she should see the doctor immediately, especially if one continues to experience breathing difficulties, shortness in breathing, constant chest pains and fatigue (which are the most common indicators of heart problems). In addition to this, women who have family members that have been diagnosed with heart related problems should also visit hospitals to be evaluated on a regular basis. This is because history of heart disease in family/ relatives is an important factor that should be put in consideration during the pregnancy.
Because of complications related to heart diseases, pregnant mothers should have frequent prenatal visits (Perry etal. 2011). This is extremely important because good patient cooperation and doctors’ care can help. In case of cardiovascular problems, medical therapy should only be conducted by trained specialists (cardiologist, obstetricians, and anesthesia care providers). During the pregnancy, the classification of the heart disease may advance from level 1 to level 4, which increase chances of miscarriage or complication at the time of birth.
Preconception counseling is also important part of the treatment. This is because some heart diseases, especially those that are congenital can result in congenital lesions to babies. Management of the cardiovascular diseases is important and it mainly focuses on “preventing hypotension and increased heart beat” (Perry etal. 2011). At the second stage, the disease should be managed through operative vaginal delivery (Perry etal. 2011). It is important to note that caesarian section should only be performed for women with obstetric issues.
In addition to this form treatment, there is a need to provide nursing care management for pregnant women so that they can recover quickly. When providing this kind of care, the doctors should combine routine peripartum care with special interest in cardiac analysis. This is essential to know the progress. The management of this problem can be addressed by strategizing on how to minimize stress on the heart. It is important to understand that the heart is more stressed between 28 and 32 weeks of pregnancy. It is therefore, significant to treat the pregnant mother against anemia, emotional stress, hypertension, and obesity, which are the main causes of stress to the heart (Ignarro, Balestrieri, and Napoli, 2007). The doctor should also encourage the pregnant mother to take a balanced diet containing high levels of iron. The mother should also be provided with folic acid (as a supplement) calories, and adequate proteins, which will help the patient to gain weight (Perry etal. 2011). The doctor should also recommend the patient to take more water. When providing cardiac medications, the doctor should also consider the wellbeing of the unborn baby. After prescribing drugs, the doctor should monitor the patient on regular basis to determine whether the drugs are affecting the fetus.
Conclusion
There are different types of heart disease, which may affect individuals. Pregnant women also suffer a number of heart-related problems and the most common one is cardiovascular disease. Heart related diseases are becoming more common in pregnant women due to several risk factors. Today, improved health care, postponing motherhood until third decade, and poor lifestyle are among the reasons why cardiac disease is common in pregnant women. The presence of cardiac disease during pregnancy poses a challenging clinical situation to medical doctors because they are also supposed to concentrate on the wellbeing of the unborn baby. Because complications of the heart during pregnancy are common, it is extremely important for pregnant women to understand the risks involved. Since the pregnancy is a source of stress to the heart and the circulatory system, doctors should strive to manage this stress. There are several symptoms of heart conditions and some of most common include difficulty in breathing, feeling dizziness and constant chest pains. Other patients may experience dizziness and lightheadedness combined with fainting (Perry etal. 2011). The presence of these symptoms varies according to level of defects. It is also worthy noting that most heart diseases are easier to treat and manage if they are detected early enough. Therefore, pregnant women who feel as if they have heart problems, whether judging from the general symptoms and signs; they should consult health professionals immediately. As part of treatment, the doctor should encourage the pregnant mother to take a balanced diet containing iron. The pregnant mother should also be provided with folic acid, calories, and adequate proteins. The doctor should also advice the patient to take more water. When providing cardiac medications, the doctor should also consider the wellbeing of the unborn baby. After prescribing drugs, the doctor should monitor the pregnant mother on a regular basis to determine whether the drugs are affecting the fetus.
References
Ignarro, L. J,. Balestrieri, M. L., Napoli, C. (2007). Nutrition, physical activity, and cardiovascular disease: an update. Cardiovascular research, 73 (2): 326–40.
Northwestern Memorial Hospital (2012). Cardiac signs & symptom during pregnancy. Web.
Perry, S. E., Hockenberry, D., Mariln, J., & Lodwermilk, L. (2011). Maternal Child Nursing Care, (4th edn.). Maryland: Mosby Inc.
Sahni. G. (2012). Cardiovascular Disease in Pregnancy, An Issue of Cardiology Clinics. Philadelphia: Elsevier Health Sciences.