Tachycardia, Irregular Heart beat and Pregnancy

[MMK1]

I'm 18 weeks pregnant with a high risk pregnancy. I'm having daily problems with tachycardia, short of breath, feeling like I'm going to pass out when I stand and bloodpooling in my legs.  I am also having problems with an irregular heart beat. If I am upright when it occurs I feel like I am going to pass out. Daily high is usually 140's(highest 240). I recently had an ECHO, which showed Mitral and Tricuspid vavle regurgitation. My EKG was abnormal showing Tachycardia. The Holter monitor showed moderate arrhythmia, sinus tachycardia and Supraventricular ectopic activity. It also showed I have some bradycardia when I sleep. I have a history of Addison's Disease (on proper medication), extra heart beats, atrial fibrillation, lowblood pressure, occasional tachycardia and bloodpooling. I don't drink alcohol, coffee, pop or smoke. My cardiologist is afraid to put me on any medication because of the pregnancy and wants me to lay down as much as possible. My thyroid, sodium, potassium and other bloodlevels are normal.
Questions:1. Should I be on medication? If so, what is safe to take during pregnancy?
2. Will the daily tachycardia and irregular heart beats damage my heart?
3. Do I have an increased risk of going back into A-Fib? Are the irregular heart beats the beginning of A-Fib but it is converting back on it's own?
4. Is it likely that the mitral valve regurgitation is causing these daily problems or is it the stress of the pregnancy on my heart?
5. Which would put less stress on my heart, a C-section or vaginal delivery?
6. Can these daily problems harm the baby?

[Cleveland Clinic]

MMK,

Thanks for the post.  I know this is a stressful situation for you. Your best bet is to have your cardiologist work with your OBGyn to develop a treatment plan. Not being able to review your primary data makes answering your questions specifically impossible.  

1. Should I be on medication? If so, what is safe to take during pregnancy?

I cant answer this. The answer depends on what the supraventricular rhythm is. If it is fibrillation, you should discuss the options of anticoagulation with your OB and cardiologist.

2. Will the daily tachycardia and irregular heart beats damage my heart?

If you have a persistant tachycardia, possibly. A low grade tachycardia is normal in preganancy. The important step is figuring out what is driving the higher heart rate -- is it normal for preganancy or due to something else.

3. Do I have an increased risk of going back into A-Fib? Are the irregular heart beats the beginning of A-Fib but it is converting back on it's own?

Atrial fibrillation can be precipitated by external stressors.  The irregular heart beats are probably PACs or PVCs if there is no mention of extended runs of fibrillation.

4. Is it likely that the mitral valve regurgitation is causing these daily problems or is it the stress of the pregnancy on my heart?

The degree of regurgitation is important and should have been quantified on the echo.  Unless severe, it is probably not a primary contributor.


5. Which would put less stress on my heart, a C-section or vaginal delivery?

C-section offers a more controlled environment for delivery.  The selection of delivery route should be between you and the experience of your OB.


6. Can these daily problems harm the baby?

There are methods to monitor the progress of your pregnancy and impact of conditions on the baby. Your Ob will measure the babies grown through the changes in your uterus size and possible through ultrasound.  These methods can provide clues to any problems with the preganancy.

Preganancy and child birth is a wonderful process.  However, even a normal pregancy is stressful.  You really should sit down and express your concerns with your OB so you dont put yourself through 9 months of excess suffering.

good luck

[I'mallheart]

wow. sounds like your not having it too good especially when this is a awesome time with the pregnancy,,,i am thankful my wife, who is 13 weeks along is doing great! i wish you health and for your baby and you get the peace and answers you need
dave
is this your first?

we have on that will be 1 yr old on march 25...so they will be 18 mos apart..busy!!

[ngkk]

First off - Congratulations on your pregnancy!  It does sound tough lately for you - I thought maybe my expierence may help ease your anxiety.  I have svt and have been on toprol for 4yrs - I did take it throughout my pregnancy with no problems with my son at all - healthy large baby.  I also nursed on toprol for 1yr and had absolutley no problems there either.  If you do have to go on meds - I hope this may help!

[jennann]

I also had more abnormal heart events than usual while pregnant, though at the times I wasn't on beta-blockers yet and didn't have afib either - but lots and lots and lots and lots of pvcs and also svt (which I've had since childhood).  It sounds like you're checking out all the right things, asking all the right questions.  You want to be very careful, of course, but it's also important to remember the resiliency of our bodies - I believe especially through pregnancy.  I also had funny heart things a bit post-partum, with all the hormone changes.  It sounds like you're smart and getting good care...try to enjoy your pregnancy and congrats!  My kids are 2, 5, and 7 - and I'd go through it all again in a .... heartbeat!

[Carolina03]

I recently had a very rough third pregnancy with SVT, similar irregular heart beats, pre-syncope and phlebitis. I also felt chest pain.

I took baby aspirin daily, ate frequent small, low-salt meals and forced myself to wear support hose, walk and rest as much as I could stand it! My cardio suggested taking a low-dose beta blocker, but I chose not to take it.

I also wrote a birth plan. If this is your first pregnancy, a C-section may be safer than a vaginal delivery, but then again, the risk for complications is higher. You should seek an opinion from a high risk OB, and schedule your birth in a hospital with a neonatal care center. If I may, I also recommend from my own experience that your birth plan stipulate an epidural and oxygen.  

Request a copy of your echo to see how severe the regurg is. The scale is 1-4 (mild to severe). By the middle of my pregnancy, three heart valves were moderately leaking, my LV had dilated, and I never felt worse but I slowly recovered postpartum. Pregnancy is not a benign state. Today I feel fine, and my son is thriving! (He can speak words in two languages at age 21 months).  

Finally, you may ask about taking a mild diuretic. Only your doctor will know if the things I suggested are right for you. I'm offering advice based on a pregnancy and birth that could've been handled much better.

I attribute my baby's overall good health to sheer grit: I forced myself to do yoga, walk and keep my legs up. I also had weekly massages. Don't laugh, this will do wonders for your blood flow! My husband also did the lion's share of the cooking and housework. Standing seem to be the toughest.

Pregnancy is one of the hardest physical and emotional challenges but you'll be so much stronger for it, and no matter how much suffering you feel now, you'll forget it when you hold your baby in your arms.

From someone who has been there ...

Best,
C

[MMK1]

Thank you for your messages. This is my second pregnancy. During my first pregnancy I was on bedrest for non-heart related complications, but I ended up going into atrial fibrillation. Thanks again!

[Artieee51]

First, to MMK1 congratulations on your pregnancy!

I should say up front, I am a 53 year old male who had triple bypass surgery 6 years ago. I had to go through heart rehabilitation (treadmilling) for 2 months after the surgery to get my heart back in shape again. My heart rate and blood pressure came down dramatically each week.

Now for the heart rate problem. I should say I am not a doctor. However, having had triple bypass surgery 6 years ago, and having several attacks of tachycardia and irregular heart beats ever since, I have learned a little something about this. One night my heart rate went up to 200, and the paramedics were panicky trying to get it to come down. I think I ve finally gotten my heart fairly regular and cut down on the irregularities. By the way, the irregularities were from the medications I was put on, one of them digoxin. I discovered that some of them deplete the magnesium in your body, so your heart skips a beat here and there.

Now for the high heart rate. My resting heart rate used to be about 85, and the cardiologist asked me to exercise and get it lower, at least down to somewhere around 70. I didn't believe him at the time, or do what he asked for weeks. I WAS WRONG. I started exercising (treadmill)on a daily basis. I didn't even have to run. Just a slow walk to start with. I worked my way up to a half hour each time, starting off very slowly and gradually working my way up higher.

They say once you start aerobic exercise and keep it up, your heart gradually gets stronger and pumps more blood each time it beats. As it pumps more blood, it will begin to slow down, and your blood pressure will drop, because it gives the body more blood for each beat than it used to. So it doesn't have to beat as fast or as hard.

WEll, I m here to tell you IT WORKS! I ve been treadmilling for several years now. My resting heart rate is as low (get this!) as 50 beats per minute. Thats right!  50 beats per minute. I would not have believed my heart rate could drop so low. Now i understand runners and swimmers and other athletes have heart beats that are often as low as 40! Imagine!

So what does that have to with pregnancy and fast heart rate. Well, pregnancy is a stress on the body, as any woman knows. And extra stress causes the heart to pick up speed. They say you can expect your resting hear rate to beat up to 15 beats faster when you're pregnant.

Think of it this way, then. If you have not been doing aerobics and bringing your heart rate down, and your resting heart rate is already as high as, we ll say, 80 or so, think what happens when you get pregnant. OOOOPs  it might go higher by about 15 beats, and suddenly your resting heart rate is 80+ 15= 95!  And that's at rest!  I just met a woman, first pregnancy, whose heart rate is 100 now, and she is scared.

Think about this now. You could exercise with even slow walks, enough to work your heart on a daily basis, and you slow your resting heart rate to, say, 75. I have found that when my heart races, even taking one step every couple of seconds will make my heart slow down. So, if youve gotten your resting heart rate down to 75, and it speeds up 15 beats, that's 75+15= 90. Already, you resting heart rate is slower than if you had not been exercising and brought your resting rate down to 75. So imagine if you could get your resting heart rate even slightly lower, say 70, and it speeds up with pregnancey, 70=15+85. That's my theory. I invite you to talk to your doctor about that. I have  found that aerobics has done some very good things for me, in heart rate, blood pressure, and my ability to cope with stress in general.  

What did it do for my blood pressure? It brought my blood pressure down from 120/80 to as low as 110/60 by building up my heart muscle through exercise. That's right.

The difference is amazing. I wouldn't have believed just walking or treadmilling or some aerobic exercise could do such things for my heart.

If you would like any other suggestions that have helped me, message me here or at my email  

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Art