Pulmonary Hypertension Expert Forum
Late term pregnancy and pulmonary hypertension
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Pulmonary hypertension is a condition associated with high blood pressure in the arteries that connect your heart with your lungs. It is a serious condition for which there are many emerging treatments but no definite cure. In this disease, the blood vessels that carry oxygen-poor blood from your heart to your lungs become hard and narrow, which causes your heart to work harder to pump the blood. This forum is a place to ask questions about Pulmonary Hypertension. Some examples are: What caused me to get pulmonary hypertension? How is pulmonary hypertension diagnosed? What treatment options are available?

IMPORTANT!! If you have a question that requires immediate medical attention, or if you think you may have an emergency situation, please call your doctor or 911 IMMEDIATELY!

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Late term pregnancy and pulmonary hypertension

Im 34 weeks pregnant and was told I have moderate pulmonary hypertension I
have scared to death because everything I read has a bad outcome my?  Is can you survive having a baby with this disease ... im having more test yo confirm because one doc seems to think I have it and the other says I just don't look or act if I have it please give mr some insight
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1884349_tn?1353818598
Thank you for your question and welcome to the forum.

First, let me address the question of pulmonary hypertension and pregnancy (which is not clear to me yet that you have so this answer is not intended to make you worry).  The combination of pulmonary hypertension (PH) and pregnancy is an extremely serious issue.  In fact, it is so serious and potentially life threatening, that we often recommend to patients with PH that they not get pregnant at all.  One of the reasons why PH is such a problem in pregnancy is because of the major changes in physiology that occur during pregnancy in general.  During a normal pregnancy, there is a significant increase in the amount of blood the heart needs to pump to support the baby (called the cardiac output).  The heart of a patient with pulmonary hypertension is already quite strained such that the increase demands it faces during pregnancy can “overwhelm the system” if you will and can cause severe right heart failure.

Second, and as I frequently point out, not all PH is created equally.  In fact, the VAST majority of patients with PH do NOT have the type of PH that is referred to when people talk about how risky pregnancy is in patients with PH (like I alluded to above).  It is thus critical to know what “type” of PH you have and how the diagnosis was made.  When evaluated by a PH expert, there is almost never any question of whether one does or does not have PH…thus, the fact that your doctors are “disagreeing” over whether or not you have PH gives me a certain degree of pause.  

Thus, my questions for you are:
How was your “PH” diagnosed?  Did you have an invasive procedure called a cardiac catheterization or was it determined from an echocardiogram (i.e. an ultrasound)?  And how/why was this even discovered in the first place?  

If you truly do have PH, then it will be very important that you be cared for by physicians experienced and expert in this disease.  We have successfully managed many patients with PH through their pregnancies with good results.  However, a multidisciplinary approach to the management of patients with PH during pregnancy is of critical importance for successful outcomes (ie PH experts, OB/GYNs, anesthesia, etc).

Best,

Dr. Rich
5 Comments
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Avatar_f_tn
Thank you so much for replying.Ok I went into the hospital for a fast heart rate they admitted me and did an ultrasound of my heart and that's how this came about I really don't have the symptoms of ph I mean I had tacnachardia with my last pregnancy towards the end so that's what I thought was going on again I was never expecting to here that I have ph the ultrasound was done by a tech im assuming and he gave the results to a cardiologist that gave my ob the results stating that I had moderate pulmonary hypertension and an enlarged right heart pressure was 58mmhg so my ob sent me to a high risk ob that seems to think its a misdiagnoses so im having another ultrasound done in Chattanooga but in so scared what are my chances if I do in fact have this I mean I really don't have any major symptoms I have a fast heart rate and sometimes I get short of breath but no more then any pregnant woman at 34the weeks I have no edema so im really confused what would u think
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Avatar_f_tn
And also let me add that im also over weight im currently 214 this is as big as I have ever been can that and being pregnant complicate the diagnoses or have an effect on the ultrasoundat all
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1884349_tn?1353818598
Hi. I am sorry for the delay in getting back to you.

I suspected that the diagnosis of pulmonary hypertension was likely made by echo (and not directly with a cardiac cath).  Echo is notoriously unreliable in making the diagnosis of pulmonary hypertension (it causes both false positives and false negatives).  Also, in normal pregnancy, the amount of blood your heart is pumping goes up significantly and can sometimes falsely suggest the presence of PH by echo (and being overweight can also make the echo pictures more difficult to interpret).

I am glad that you are getting a 2nd opinion.  If at any point anyone wants to give you a confirmed diagnosis of pulmonary hypertension without a cardiac cath, then find another doctor (you can even come see me---chicago is not that far from chattanooga!!).

Good luck with the rest of your pregnancy.  I wish you all the best.

Dr. Rich
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Avatar_m_tn
Thank you both for your question and for your answer!  You have no idea how much you have relieved my anxieties about this subject.  Let me tell you my story.  When I was pregnant with my first son occasionally I would feel my heart racing when I did small things, such as brush my hair.  I asked my doc about this and he said it was normal due to the extra blood my body was producing and circulating through my body.  With my second pregnancy, I had moved away from my family to a different town with my husband,  Within a month of moving I became pregnant.  I was very nervous and began having panick attacks (mostly from stress I think).  Anywho, I began experiencing the same thing as far as my heart being a little sensitive to normal activities, and it FREAKED my new doc out.  Mind you, at a prior appointment he diagnosed me as having OCD due to my panick attacks and ordered me to take Prozac. (I do not have OCD) He sent me to a cardiologist, where I got an ECHO.  At my next ob appt, I hadnt heard anything from the cardiologist, and my ob doc asked about my results which I told him I hadnt gotten.  Because the offices were in the same building he was able to have them faxed to his office.  When he got the results, he wanted me to get another echo done because of "possible pulmonary hypertension."  I freaked out and got a new doc.  My new doc said there was nothing to worry about and ended up having a beautiful pregancy and now a beautiful baby girl.  My daughter is now 7 months old and I just recently got enough courage to talk to my family doc about what my OB doc and said about my "possible PH."  I am going tomorrow morning get his opinion.  I just wanted to thank you for easing my mind and I won't settle for another ECHO.  Thank you, thank you, thank you!
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1884349_tn?1353818598
Jonathan D. Rich, MDBlank
Northwestern Memorial Hospital
Chicago, IL
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