Re: Heart Attack

Posted By CCF CARDIO MD sc on February 10, 1998 at 17:02:54:

In Reply to: Heart Attack posted by Pam on January 29, 1998 at 11:27:35:







: I am a 29yr old female who is recovering from a pretty massive heart attack as a result of a blood clot that ended up in the largest artery in my heart.  The Doctors informed me (in passing) that I would not be able to have children because of the attack.  Have women gone on to have children after a heart attack?  Are the risks really that high if I were to become pregnant?  Wouldn't a csection eliminate the added stress to the heart?
Thanks!



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Dear Pam
I would first like to apologize for the delay in answering your question. Your problem is not an easy one to answer without have a more detailed account of your history combined with a full clinical evaluation. What I will therefore attempt to do is to give you some general information  about  the physiologic changes that occur during pregnancy and how these may effect the cardiovascular system.
Pregnancy is a very stressful period for the heart due to a number of changes that take place during the 9 months of the fetuss development. The cardiac output ( the amount of blood the heart pumps per minute ) starts to increase by the 5th week of pregnancy and continues to do so until it reaches about 45% above baseline at around the 24th week. The heart is able to achieve this by increasing its rate ( the heart rate increases until the 32nd week ), and increasing its squeeze ( called stroke volume ). This increased work on the heart is further compounded by labor which induces a further 12% increase in the Cardiac output in the first stage of labor and ultimately increases up to 34% above the pregnancy baseline are achieved by the end of labor.
Other changes seen are an increase in the mass of the heart probably secondary to the increased workload, an increase in the volume of blood in the circulation and an increase in the red cell mass ( although this is relatively less than the increase in the plasma volume and may give a relative anemia ).
Most women are able to tolerate these changes relatively easily because most are relatively healthy and young with a very low incidence of heart disease during the  child bearing age. It is however clear to see how a heart that is diseased, even if well compensated  may be thrown off balance by pregnancy. The heart may not be able to cope with the increased stress  and this may have severe consequences on the mother and the child, which depends on the maternal heart while in utero. As I have outlined above this  increased stress is taking place throughout pregnancy and not just in labor so c-section does not decrease the risks.
Another consideration that has to be looked into is the medications you are on. There are certain medications including the class of drugs called ACE inhibitors and also anticoagulants which are of significant importance for patients who have suffered a major heart attack but which are contraindicated in pregnancy because of increased teratogenic effects in utero.
I would also like to stress that  there is also limited experience with this kind of problem because as you are well aware the incidence of  coronary artery disease in women of child bearing age is very rare.
In your case I would recommend a very careful evaluation by a cardiologist preferably with a special interest in the field. This would entail a careful determination of your heart function and to assess the residual impairment left after your heart attack. This will have to be combined with a careful evaluation of your current medical regimen. A determination of residual coronary artery disease and possible silent  disease would also have to be considered.  It is only at this  point that a clear indication of your particular risks may be determined. I hope this will be of some use to you and I wish you the best of luck. If you have any further questions or would like to be seen by one of our specialist here at the clinic please feel free to call 1-800-CCF-CARE for an appointment. Information in this forum is intended for general purposes only, specific diagnosis and treatment should be reserved for physicians directly involved in patient care.