Hypertrophic Cardiomyopathy and Pregnancy

[nicolawk]

My daugher is 24 and ten weeks pregnant. She was diagnosed with HCM at age 20. Her pregnancy wasnt planned and I am very worried whether she should even be pregnant, given her heart condition. Her symptoms are mild but her condition real.

Will she be able to give birth normally? Is she at risk of dying during her pregnancy? Is it high risk for her unborn baby?

I am her mother and very worried. My daughter wants to have a baby now while she is young and not later as she feels her condition will worsen in time.

Thank you.

[CCF-M.D.-BJ]

Hi Nicolawk,

Congratulations on the news of your daughters pregnacy, although I understand your concern.  HCM is a highly variable disease in its presentation.  It depends on many different factors like her pre-pregnancy symptoms, the thickness of her heart, family history of sudden death, etc.  Her pregnancy is higher risk than a pregnancy is someone without HCM, but it is difficult to say how much different.  In general, giving birth with HCM is safer than with many other congenital heart disease variants.  The reason is that many other disease states get into trouble because they cannot tolerate the high intravascular fluid load associated with pregnancy.  In many cases, HCM actually does better with more intravascular fluid.

You need to see a hypertrophic cardiomyopathy expert to help assess the risk.  If your cardiologist is comfortable doing this, that is ok.  If not, Harry Lever here at the cleveland  clinic is a very thoughtful and concerned physician that I have a lot of respect for.

The risk of giving birth is never zero and her risk may be slightly greater than normal, but to figure out how much, she will need to see an expert.

I hope this helps.  Good luck and thanks for posting.

[sugarcane]

I have hypertrophic cardiomyopathy and had 3 uneventful pregnancies. I did have trouble with the spinal anesthesia (blood presure became very low) as mine were all C-sections. From what I have been told now, spinals and even epidurals are contra-indicated in HCM patients for that very reason. The pregnancies themselves were fine. The c-scections were not done because of my HCM but rather because I tend to have very large babies and don't have a large pelvis. Of my three children, ages 12, 14, and 17, the 14 year old has also been diagnosed with HCM. As you probably already know, research shows that each child of a hypertrophic parent has a 50-50 chance of also inheriting the disease. My children are screened every year since age 10 with EKG and echoes. Best of luck to your daughter for a wonderful pregnancy and delivery.

[tickertock]

Can I ask, does anyone diagnosed with HCM know the dimensions of your left ventricle? I have mild LVH that's the only thing out of range on my echo, I am told its caused by mild hypertension. I have no history of HCM or sudden cardiac death in my family whatsoever. I am a 41 year old male, history of palpitation, anxiety and PVCs, also diagnosed 5 years ago with a connective tissue disease.Thanks in advance.

[sugarcane]

From my understanding, a slightly thickened posterior wall (if that is what you are meaning by saying left ventricle) is indicative of hypertension or can also be found in highly trained athletes.The most common characteristic of HCM is a thick septum. If the walls are ALSO thick, it is called concentric HCM. This is less common than straightforward HCM or HOCM. This, at least, is my understanding.

[tickertock]

Thanks for the info, it is my interventricular septum that is about 2mm thicker than it should be , all my other dimensions are within the normal range. I was worried about HCM but the cardiologist doing the echo assured me I don't have HCM, just mild LVH.Sometime you can't help being concerned, Thanks again.

[nicolawk]

Thank you for your post.

I was unaware that there are "HCM Experts". My daughter sees a cardiologist here in Sydney, Australia. He comes highly regarded and my daughter feels very safe visiting him.

I accompanied her on her recent consultation and this man just smiles all the time. He told that the gene responsible for HCM can be less severe or very severe. He requested blood work two years ago for which he has not received a conclusion. This blood work was to determine if she has the more severe gene or the less severe gene. Does this make any sense?

Thank you for your congrats. It is exciting when you child falls pregnant, only this child has a heart condition that scares her mother. She wants a child now because she feels her lifespan wont be as long as those without this disease and if she waits then her time with her family will be shorter. It's very distressing hearing her talk this way.

[meikman]

I notice you said who where Dx with a connective tissue disorder could this be Marfan Syndrome?  I am just wondering.  My uncle and his two sons had this.

[tickertock]

I have been diagnosed with Ankylosing spondylitis.

[mkdd]

OHeloo to everyone I just had a baby 4 months ago and was sent to the er at 5 days post op. I there was dignosed with peripartom cardiomyopathy. I just had another eco and my ef is good 55% but my left vet is still dilated I was wondering what is the normal range for the ventricle. also what is trival mitral reguritation and trivial tricuspid regurgitation? I am going to see a cardiolgist on Monday the 20th but I am curious to know what all this is and how can it be fixed or can it.

[micangelab]

Sugarcane, can I ask you what they did for your c-section being your blood pressure dropped? I am due to have a c-sectio and are really worried about this factor. My blood pressure already runs on the low side. I also have many PVCs and PACs. Also fluttery feeling in the chest that they have thought might be AF. I am just so nervous about everthing at this rate. TY