Possibility of a 2nd pregnancy

[beccaelizabeth]

I am a 27 year old active female in good shape with a few questions about my 8-yr.history as a cardiac patient.As a result of a pregnancy at the age of 19, I developed a severe case of eclampsyia/toxemia which led to CHF.Initially, my symptoms (headache, high bp, swelling)were taken very lightly, but I eventually had to have a C-section due to the instability of my BP.After my daughter was born, I cntd. to have symptoms that worsened while still in the hospital, but I was told that I was behaving in a "post-partum" manner bcs. the birth of the baby should have eliminated any physical strains on my body.By the time I was taken seriously, I was in full-blown CHF and had a seizure on a mag drip bcs.my BP was 198/125 and untreated.A cardiologist was called in and diagnosed the CHF as well as peri-partum cardiomyopathy.He told my family that I would most likely not make it.After leaving the hospital after almost 3 wks.,I was followed for severe MVP/regurge and medicated for appr. 2 yrs. I have since then cntd. to improve my health as much as possible and am still followed. My last appt. showed only trace (normal) regurge, virt. no prolapse, great pressures, BP back to 110/60, no symptoms, and my EF up to 58--all without any meds. My question is this: I am going to be married soon and very badly want a second child--is this something I could consider? I feel that my case was a poorly managed one, and had I been treated as needed from the start, I may not have been in such bad shape. My doctor has advised against a secoond pregnancy, but I feel great.Should I get a 2nd opinion?

[Cleveland Clinic]

becca elizabeth,

My question is this: I am going to be married soon and very badly want a second child--is this something I could consider? I feel that my case was a poorly managed one, and had I been treated as needed from the start, I may not have been in such bad shape. My doctor has advised against a secoond pregnancy, but I feel great.Should I get a 2nd opinion?


Becca,  you should get a second opinion if nothing else for peace of mind.  Your case is quite complex so I cannot really giv e you firm recommendations.  I can say, if you had a peripartum cardiomyopathy, a second preganancy would be generally contraindicated.  Even in those that regain normal cardiac function, the recurrence rate is high.

My recommendation would be to seek evaluation from a cardiologist who specializes specifically in heart failure and from an OB-Gyn who specializes in Maternal Fetal High Risk Medicine.  A review of your case should lead to a consensus of your first preganacy and further recommendations.

good luck

[beccaelizabeth]

I forgot to mention that before my pregnancy, I had no history of any heart problem. I developed an innocent murmur when I was approx. 16 mos. old that was never considered to be of any significance. As a teenager, I was very active in school athletics and continued in distance running up until I became pregnant. I can only assume that my mitral valve issues stemmed from pregnancy complications, but I am not positive of this.

[Kristin391]

I know you would like a second child but this is where you count your blessings and take the advice of your physician.  I have heart failure and have a lot to deal with so the fact that you don't have to take drugs, EF back to 58% which is great you ought to feel very lucky.  There is such a huge risk for this to all reoccur.  You do not want heart failure at this young age or even worse.  I know several young women who had a peripartum cardiomyopathy and are chronically ill etc.  So good luck to you.

[beccaelizabeth]

Hi Kristin,
Thank you for your comment--I have really struggled with all this. I know I am incredibly lucky and far more fortunate than others that have been in my situation. There are so many uncertainties about my case, that I am not sure of the severity. As I mentioned in my posted question, I don't know if my case was just poorly managed, or if I really am at high risk of another episode of heart failure with a 2nd pregnancy. Afterall, I certainly want to be around for the daughter I have! I hope you are doing well. Take care,
Becca

[uptowngirl]

Hi beccaelizabeth,

So sorry to hear of your challenges, and am glad to hear that you are doing well now.

I've been down a similar road, but not nearly as extreme (mitral valve/MR problems), and had a couple of thoughts to pass along.

Would adoption be a possible consideration for you and your fiance'?  

Also, when we talked to our cardiologists and got a second opinion, they also had us consider the chances of any future children inheriting my heart condition,(even though they said it was about a 25% chance) which caused us to think that aspect through.  I don't know if there is a hereditary link in your situation, but just thought I would mention it.

Yet, I do understand your dilema, we did not want to have an only child and waited 6 years before having another child, but it was a rough road all the way.  But after reading your scenario, I think my situation was a walk in the park!

All the Best,
uptown

[Carolina03]

BeccaElizabeth,

I'm 37 and went through hell during my third pregnancy, was diagnosed with peripartum cardiomyopathy and finally coronary vasospasms a year after delivery.

Fortunately, my heart's no longer dilated but I'm on medications indefinitely for the chest pain. The pregnancy impacted my aortic valve, causing regurgitation which then damaged the valve, so I may need OHS sometime in the future.  

I'm not trying to scare you out of having a child with your future husband, but please consider the possible, irrepairable consequences. Certainly seek the opinions the cardio recommended before making your very difficult decision.

God bless,
Caroline

[beccaelizabeth]

Thank you for the comment--I'll tell ya, sometimes it feels like there's no one out there who understands or has had similar experiences.  

My fiance and I have definitely have looked into our alternatives. Adoption seems to be what we are leaning toward.  I talked with him and family members and everyone seems to concur--it seems like it is just too risky. I don't want to be in the situation where my life and/or a child's life is compromised. I guess I was just hoping that it was kind of a fluke the first time.

It would also be an unfortunate thing for a child to inherite my condition. As sad as it makes me, things could have definitely ended up a lot worse! Thanks again for your thoughts--take care!

Becca

[beccaelizabeth]

Hi Caroline,

I am sorry you are going through such a tough time. Your comment really hit home. Afterall, if I did get pregnant again, I don't think they could do a whole lot for me or the baby if I went into a crisis situation.

Did you have any heart complications prior to your 3rd pregnancy? What were the symptoms of the coronary vasospasms?

Best of luck,
Becca

[Carolina03]

Hi, Becca.

Thank you. No, I was never even aware that I had a "physical" heart before the third pregnancy, although I was told I had a murmur two years prior.

The spasms are a recurring pain under my left breast that radiate down my left arm (or up my sternum,,neck and jaw during more severe episodes). During my last trimester, it felt like how they describe "classical" angina: crushing, strangling chest pressure. I was told it was reflux by my OB.

15 months, a full GI work-up, three echos, one thallium stress test and cath with a ergonovine, and I was finally treated for vasospastic angina.

Young women, welcome to the world of modern medicine!

My symptoms are 90% relieved by a long-acting nitro and calcium channel blocker. Before I started the medications, I felt like a locomotive train.

I'm trying to keep it light (avoid stress), exercise, take my meds and hopefully help other women in similar or potentially similar situations.

All the best,
Caroline

[Carolina03]

Anacyde,

I think the bottom line is ... how do you feel today?

A lot of pregnancy-related cardio symptoms or changes disappear over time. Pregnancy is not benign though. I'm hoping a year from now I'll be off the meds and running on the beach again!

If you're feeling well, and your echo was normal, then I would enjoy and live your life to the fullest! If it helps, plan another appt. with your cardio in a year's time to confirm the latest findings.

I hope this helps.

Caroline

[beccaelizabeth]

Hi anacyde,

Like you, I am always drawn to the pregnancy related questions! I think that's understandable considering that many of us (you, myself, and Caroline who posts, just to name a few) have had really scary things happen to us during/after pregnancy that no doctor has ever really been able to explain or define. I have pretty much decided to not pursue the possibility of having a 2nd baby, but just to have a better understanding of what has been going on with me, I think I am going to visit a CHF specialist that I found online.  I think if you are feeling unsure about how your health would fare throughout another pregnancy, maybe you should consider the same. It was also reccommended to me that I visit a high-risk OB/GYN when I was considering pregnancy. I live in Virginia Beach, VA and was able to find a CHF specialist in  Richmond through a website called chfpatients.com. If you feel like you need to rule out that possibility, then I'm sure you could find a CHF specialist in your area. I look at it this way, when it comes to even just a remote possibility that your health or your baby's could be in danger, it is still 110% worth it to have it checked into.