Arrhythmia and pregnancy: how to safely carry a baby

Causes of arrhythmia during pregnancy

Pregnancy is a risk factor for an irregular heartbeat. There are explanations for this:

1. Hormonal changes. The natural growth of progesterone and estrogen has a proarrhythmic effect on myocardial tissue.
2. Increase in circulating blood volume by 20-30%. This leads to stretching of the atria, and the rhythm is disrupted.
3. Physiological increase in heart rate. On average, heart rate increases by 15-20 beats per minute compared to the initial data. Against the background of natural tachycardia, the volume of cardiac output increases, and arrhythmia develops.

Cardiac arrhythmias are detected in 10-12% of all pregnant women (according to some authors - up to 20%). The prevalence of pathology among expectant mothers is higher than among women outside the gestation period. Arrhythmias can be newly diagnosed or formed before conception. Often it is not possible to find out the exact reason.

It is important to understand: not all heart rhythm disturbances in pregnant women are associated with organic damage to the myocardium. In practice, we often see that heart failure is caused by various conditions, including endocrine pathology, diseases of the nervous system, etc. The medical literature indicates that up to 45% of gestational arrhythmias are of functional origin and occur even in healthy women.

There are such causes of arrhythmias:

• functional states: the use of certain products (tea, coffee), smoking, stress, physical activity;
• organic damage to the heart muscle: ischemic heart disease, heart defects, myocarditis, pericarditis, neoplasms;
• autoimmune diseases;
• bronchial asthma, bronchitis;
• violation of cerebral circulation;
• pathology of the thyroid gland, adrenal glands;
• intoxication with alcohol, drugs.

Arrhythmia in pregnant women develops more often when carrying a large fetus, multiple pregnancies and polyhydramnios.

Symptoms of heart rhythm disturbances

Sinus tachycardia usually occurs in stressful situations, even in absolutely healthy people. It is characterized by: dizziness, tinnitus, flashing "flies" before the eyes, shortness of breath, facial flushing, tingling in the fingers, loss of consciousness, nausea and even vomiting. For more serious arrhythmias, the same symptoms are characteristic, so if they occur, you need to see a doctor.

Diagnostics

Diagnosis of cardiac arrhythmias, like treatment, is always carried out in a comprehensive manner.

The survey includes:

• Listening at the first reception
• ECG passing
• Blood and urine tests

The initial examination allows you to determine the heart rate, sequence and heart rate, the general state of health of the patient, the presence of factors that could provoke the development of pathological states.

If arrhythmia occurs spontaneously and does not depend on activity and time of day, Holter monitoring is performed. This technique consists in round-the-clock recording of the heartbeat using special equipment. Exercise studies (on a treadmill or other exercise machine) are also conducted.

To clarify the diagnosis and identify the causes of the pathology, other studies can be carried out.

These include:

• Ultrasound of the heart
• Doppler ultrasonography of blood vessels
• Echocardiography, etc.

If necessary, the patient is referred for consultation to other specialists (endocrinologist, gynecologist, etc.).

Types of arrhythmias during pregnancy

Arrhythmia is a serious medical problem. Cardiac arrhythmias pose a threat to the formation of the fetus and the course of gestation. Complications may develop:

• spontaneous miscarriage;
• gestosis;
• premature birth;
• chronic hypoxia and fetal malnutrition.

Practice shows that the risk of complications is higher with previous cardiovascular pathology.

Let us consider in more detail what forms of arrhythmia are detected during gestation. and how to recognize them by their characteristic features.

Extrasystole

Extrasystolic arrhythmia is the most common type of heart disorder in pregnant women. It occurs mainly in the third trimester, often asymptomatic. It is accompanied by interruptions of cardiac activity and other nonspecific signs.

This pathology is characterized by premature contractions of the heart. The patient during an attack feels fading or tremors of the heart muscle

Short-term extrasystole is not dangerous for the health of the mother and fetus. The resulting hemodynamic disturbances do not interfere with the course of pregnancy. With the progression of the pathology, fetal hypoxia develops. The risk of complications is higher with concomitant heart disease.

Wolff-Parkinson-White syndrome

WPW syndrome is a form of supraventricular tachycardia. Observations show that this form of arrhythmia in pregnant women is rare and is usually associated with a previous heart pathology. The anatomical substrate of the disease is the formation of additional atrioventricular pathways ("bridges"). The bioelectrical impulse from the sinus node spreads abnormally quickly and can move in a circle.

WPW symptoms are nonspecific. Pathology is detected on the ECG. During an attack, the heart rate reaches 200 beats / min. Atrial fibrillation and cardiac arrest are possible.

Paroxysmal tachycardia

Paroxysmal conditions rarely occur during pregnancy without prior background. They usually complicate myocardial ischemia. Localization can be atrial and ventricular.

An attack of paroxysmal tachycardia occurs suddenly. Heart rate increases up to 200 beats / min. There may be complaints of tinnitus, dizziness. In pregnant women, an attack often proceeds against a background of nausea. Possibly reversible speech impairment.

A prolonged attack of paroxysmal tachycardia is dangerous for the mother and fetus. Termination of pregnancy is not excluded.

Atrial fibrillation

This pathology is characterized by a correct rhythm with a very rapid (up to 240 beats per minute) heartbeat. Patients suffer from weakness, increased sweating. Some patients with an attack fall into a light-headed state.

Sinus arrhythmia

With this option, the normal rhythm of the heartbeat is disrupted, it becomes chaotic. At first, it can become more frequent, then slow down, followed by normalization. The intervals between individual contractions take on a different length of time.

The cause of the pathology is a malfunction of the sinus node. It is through it that an impulse passes with a certain frequency. But if the rhythm is broken, the node sends signals at different intervals. All parts of the heart contract sequentially, but without a clear rhythm. This is how sinus arrhythmia develops.

In clinical cardiology, it is customary to separate respiratory arrhythmia. Here, violations are associated with movements of the chest during inhalation and exhalation.

Sinus arrhythmia during pregnancy is usually harmless to the mother and fetus. Such attacks do not affect the general condition of the body and have a short duration. But, if the woman's well-being worsens, the fetus suffers, a consultation with a cardiologist and the selection of therapy are indicated. Progressive sinus arrhythmia during pregnancy threatens the development of fetal hypoxia, premature birth.

Other types of cardiac dysfunction during pregnancy

Sinus tachycardia. This is a contraction of the heart, accelerated to 100 beats per minute or more, coming from the sinus node, which is responsible for the normal contraction of the myocardium. At the same time, the heart rate gradually increases and also gradually decreases. This type of tachycardia is considered a normal reaction of the heart to emotional and physical stress. In particular, it arises as a compensatory response of the cardiovascular system to fever, hypoglycemia, shock, hypotension, hypoxia, anemia, myocardial infarction, pulmonary embolism, hyperthyroidism, taking certain medications and exposure to toxic substances.

Chronic inadequate sinus tachycardia is pathological. It differs from “normal” tachycardia in that it occurs without the influence of obvious physical or emotional factors.

Sinus bradycardia. This pathology is characterized by a pulse rate of less than 55 beats per minute and can occur even in absolutely healthy people in a dream or a state of rest.

Features of sinus arrhythmia during pregnancy

From the very first days of pregnancy, a woman's heart begins to beat much faster. True, this symptom is not always joyful. It can be provoked by various processes in the body. These include sinus arrhythmias.

The amount of blood that circulates increases significantly, by about 20%. This provokes the formation of another circle of blood circulation (additional). It is he who connects the mother with the child. This process significantly increases the load on the heart. The increased activity of the nervous system develops. Stress tolerance is not that good. Electrolyte disorders are directly related to toxicosis, which further complicates the condition. The hemoglobin level drops significantly. Dysfunction of the thyroid gland is observed. All this knocks down the level of normal heart rate.

During pregnancy, all chronic processes in the body are exacerbated. Therefore, a violation of the heart rhythm is to some extent the norm. The main problems include congenital heart defects, pathological foci of excitation. Sinus arrhythmia can occur against the background of atrial fibrillation, extrasystole.

Often, the main pathogenesis of sinus arrhythmia during pregnancy is a metabolic disorder in the heart cells. This may be due to a lack of potassium, magnesium and sodium. So, an excess of these components in the body leads to the development of cardiovascular abnormalities.

All this leads to a significant deterioration in conductivity. This process leads to painful sensations in the area of ​​the heart and chest. If an increased concentration of potassium is observed in the body, a lethal outcome is not excluded.

Pathological changes in the myocardium often lead to the development of ischemia or rhythm disturbances. Moreover, in some cases, everything is irreversible. Organic changes contribute to the development of arrhythmias, especially if they are localized in the area of ​​the sinus node. The cause of the phenomenon can also be a congenital defect.

Shifts play a special role in pathogenesis. This concerns the content of potassium, sodium, calcium and magnesium. They must be inside myocardial cells in an acceptable amount. Any shifts lead to the appearance of excessive excitability, conductivity of the sinus node. All this entails a contraction of the myocardium. Rhythm disturbance occurs against the background of increased activity or, on the contrary, complete depression of the sinus node. With the shortening and lengthening of the refractory period, pathological changes. To a greater extent, everything is associated with pathologies in the heart itself.

Pregnancy prognosis for heart failure

The prognosis of pregnancy with such an ailment completely depends on the work of the woman's heart. After all, each person reacts to different events in a special way. Arrhythmia during pregnancy is not the easiest condition. Usually, 19-20% of girls may develop organic myocardial damage. If a representative of the fair sex suffers from late toxicosis, then it will definitely not be possible to bypass the arrhythmia.

There is no particular danger of a rhythm disturbance that has complete or incomplete

atrioventricular block. Pregnancy increases the ventricular rate. In this case, during childbirth, you will have to use the imposition of obstetric forceps.

If the pathology is organic, the preservation of pregnancy is contraindicated. The likelihood of a bad outcome for both the mother and the baby is high. The method of delivery is very important in this case. Even a cesarean section can trigger thromboembolism.

Therefore, what the prognosis will be depends on the individual case. It is impossible to say unequivocally. You just need to be constantly under the supervision of a doctor, and to act on his recommendations.

Sinus arrhythmia treatment during pregnancy

It is quite possible to cure an ailment during pregnancy, however, the process is not easy. In a woman's body, cardinal changes take place, so the dosage of drugs, and the drugs themselves, must be selected properly. In any case, it is important to maintain the tone of the heart. It is necessary to take into account the fact that the body is capable of rejecting medicines in every possible way.

The approach to fixing the problem must be careful. After all, it is worth considering not only the reasons for the appearance of this process, but also possible complications. First of all, you should stop drinking alcohol (yes, some mothers allow themselves this luxury). Remove hyperthyroidism, if any, eliminate any consequences of an overdose of glycosides.

You need to constantly monitor the state of the heart. This will prevent possible manifestations of seizures during pregnancy. Prevention of thromboembolism must be performed without fail.

Medical treatment is not recommended. Yes, and natural childbirth should also be abandoned, perhaps a violation of the heart rhythm directly during the birth process. Treatment is carried out exclusively after a quality examination. An ECG will allow you to find out in what form the ailment is, as well as identify possible other deviations. If the deviations are minor, there is no specific treatment. To prevent rhythm disturbances, it is enough to simply lead a healthy lifestyle and be more outdoors.

Drug treatment

During pregnancy, any medication should be used with extreme caution. There is always a risk of developing unforeseen complications. Dosage adjustment is carried out directly by the attending physician. The dose is calculated based on the woman's condition, as well as the concentration of certain substances in the blood serum. Supportive therapy during pregnancy may not be effective. More precisely, it is difficult to pick it up due to changes in the body.

Despite this, it is recommended to pay attention to drugs such as Aspirin, Adrenaline. They should be consumed before labor begins. Other medicines provide not only supportive therapy, but also help the problem not to come back. Often prescribed Atropine, Furomesid, Nifedipine, Verampil.

• Aspirin. It is worth using the drug with extreme caution. The dosage is adjusted individually. Usually, it is enough to consume it at 100-300 mg per day. However, in the last trimester, such a dosage can cause inhibition of labor. The drug should not be taken by people with hypersensitivity, kidney and liver problems. Side effects: nausea, anorexia, skin rash.
• Adrenalin. The agent is administered intramuscularly or locally, at 0.3-0.5-0.75 mg. It all depends on the condition of the woman in labor. During admission, an increase in blood pressure, tachycardia is possible. That is, an increase in the already existing symptoms. Refuse to take the drug is worth people with hypersensitivity, diabetes mellitus.
• Furosemide. It is prescribed intravenously, intramuscularly, or simply inside. It is enough to take 40 mg of funds in tablets once a day in the morning. As for other methods, the dose is calculated individually. Side effects include nausea, vomiting, diarrhea, dizziness, and depression. The drug should not be taken by people with hypersensitivity, hepatic coma, hypokalemia, as well as in the first trimester of pregnancy.
• Nifedipine. It is taken internally at 10-30 mg, 3-4 times a day. The maximum dose should not exceed 120 mg. The duration of treatment is long, 1-2 months. In severe heart failure, acute myocardial infarction, severe arterial hypotension, the use of the medication is prohibited. Side effects are possible in the form of headache, nausea, palpitations. In general, the drug is well tolerated.
• Verapamil. Usually they take 80 mg of the drug 3 times a day. For pregnant girls, the dose is calculated on an individual basis. The tool has a number of side effects. It can cause gastrointestinal upset, dizziness, depression, and heart rhythm disturbances. It should not be taken by people with heart failure.

Non-drug treatment

In the treatment of arrhythmias in pregnant women, special attention is paid to non-drug methods. Recommended:

• Eat properly. The diet of the expectant mother should include red meat and dairy products, vegetables and fruits. Food should be steamed, boiled. Fried foods are prohibited;
• Move more. Fitness for pregnant women, yoga, water aerobics - everything will be good;
• Avoid stress. Any emotional experience is the path to heart disease;
• Do not overexert yourself. Serious physical activity, hard work during pregnancy is prohibited.

Operative treatment

For the first time, the elimination of the problem with the help of surgical intervention was made back in 1968. Today, this method is not used very often. The fact is that it is quite possible to solve the problem with medication. But, only in the case when it has not passed into the active stage. In the early stages, arrhythmia can be removed even with an ordinary healthy lifestyle. Refusal from bad habits, normal nutrition, sleep and rest will drive away any ailments from a person.

If the complications are serious and we are talking about heart failure, surgery may be necessary. Access to the organ is provided by bilateral transverse thoracotomy. The operation must be performed under the support of the AIK. It is impossible to do without electrophysiological intraoperative mapping. With its help, the location of the nerve bundles is determined. Despite the fact that the most modern technologies are used, they rarely try to resort to surgical intervention.

Planned operations for cardiac arrhythmias are carried out for a period of 16-22 weeks. Emergency intervention - at any time.

Prevention of sinus arrhythmia during pregnancy

If a woman began to pester with bouts of the disease, the first thing to do is to reconsider the diet. Fatty foods increase the cholesterol content, which leads to disruption of the heart muscle. Therefore, it is important to follow some kind of diet. You should give up fatty meats, tea, coffee and sugar. These foods contain high levels of cholesterol. You can diversify your food with dried apricots, zucchini, walnuts, pumpkin. They contain a lot of potassium and magnesium.

It is important to eat often, but little by little. Overcrowding is not recommended. This will irritate the nerve receptors that are responsible for the functions of the sinus node. As a consequence, there is a risk of developing arrhythmias. Eating at night is prohibited!

Features of sinus tachycardia during pregnancy

Tachycardia attacks during pregnancy are a common occurrence that accompanies the pregnancy process.

If a woman begins to feel severe nausea and dizziness, and she also has bouts of vomiting, she should definitely inform her doctor about this. Such symptoms may indicate a pathological form of the disease, which is characterized by longer and more severe attacks of increased heart rate.

During pregnancy, a woman is in no case recommended to expose herself to excessive physical exertion or experience any nervous shock. If a patient has tachycardia while carrying a fetus, then doctors strongly advise her to protect herself from all sorts of activity, to rest and relax more.

Such measures in most cases help to avoid an increase in heart rate (heart rate) and tachycardia attacks. But if after the patient's rest, this did not happen, the symptoms remained, she should consult a doctor for help.

If tachycardia during pregnancy is of a pathological nature, then this problem needs to be solved only with the help of qualified doctors in modern clinics. Therefore, it is so important to diagnose and begin to treat such a disease in a timely manner.

Labor management with arrhythmia

The question of the method of delivery is decided by a commission, taking into account the type and severity of the disease, the duration of pregnancy. Among the indications for a cesarean section:

• severe circulatory disorders;
• heart disease in combination with obstetric pathology;
• aortic valve disease;
• mitral stenosis;
• atrial fibrillation;
• coarctation of the aorta;
• severe rheumatic processes;
• myocardial infarction in a woman.

If the council allows a woman to give birth independently, it is necessary to use epidural anesthesia, shortening 2 periods due to episiotomy. The use of obstetric forceps is possible. For delivery, the recommended position is on the left side. A team of doctors monitors the woman's condition and is ready to promptly provide assistance.

Pregnancy, childbirth against the background of CVD can be dangerous for the mother and baby. A complete examination at the planning stage and follow-up by a team of specialists will help to avoid the development of complications.

Planning a pregnancy for heart disorders

Pregnancy against the background of a previous arrhythmia should be planned. If a woman has heart disease, she should consult a cardiologist prior to conception. According to the indications, treatment is carried out before pregnancy, drugs are selected that will correct the heart rhythm in the future. Such planning reduces the risk of complications and increases the chances of a successful bearing of the fetus.

The expectant mother should undergo an examination to identify possible diseases. Do not be afraid of visiting a doctor and assume that pregnancy is the condition that cures all diseases, and the very fact of its occurrence automatically recognizes a woman as healthy. To assess the risk, you need to go through:

• ECG;
• EchoS;
• stress tests to assess the work of the heart;
• MRI for aortic lesions.

If you suspect a hereditary disease, you should contact a medical geneticist. A complete examination will show if a pregnancy can be planned.

How arrhythmia in a mother can affect the health of the child

Violations of the mother's heart rhythm lead to instability of the fetal blood flow. Because of this, the blood flow in the placental system is disturbed, the access of nutrients and oxygen to the child is reduced. Violation of the baby's nutrition and breathing can adversely affect his intrauterine development, therefore, any heart rhythm disturbances during pregnancy must be corrected.

Self-diagnosis of arrhythmia: how to understand that an attack has begun

The first signs of cardiac arrhythmias are quite diverse. For example, with extrasystoles, there may be a feeling of interruptions in the work of the heart, a feeling of fading.

Paroxysmal tachyarrhythmias usually present with a rapid heartbeat (beats at a rate of 100 per minute) that suddenly begins and ends abruptly.

What can be done with a mild seizure

If a pregnant woman is alone with a sudden attack of tachycardia or arrhythmia, it is necessary to breathe deeply, as well as perform the Valsalva maneuver. To do this, close the glottis and tighten the chest muscles for 10-15 seconds (can be compared to trying to push, but do not overdo it).

Remember that the best self-help option is to call an ambulance.

Consequences of arrhythmia during pregnancy

The consequences of this disease can be serious. If we talk about the health of the mother, then the development of heart failure is possible. As for the baby, it is oppression of normal development.

With such a disease, the body begins to work hard, provoking the heart to beat much faster. All this is accompanied by unpleasant symptoms, in the form of shortness of breath, edema. If the heart on the contrary beats more slowly, weakness torments. Therefore, it is important to diagnose the disease in time. After all, unpleasant signs will constantly pester a person and ultimately lead to serious consequences. Heart failure knocks a person out of their usual rut. In some cases, it entails a disability.

Like other heart ailments, rhythm disturbance can flow into a chronic form. In this case, negative symptoms will constantly pester the person, for periods very strongly. In order to avoid all sorts of complications, you should constantly monitor your own health. A correct lifestyle and timely diagnosis will avoid many problems.

Of course, sinus arrhythmia during pregnancy can cause a number of complications.

The most moderate is a smooth flow into a chronic form. This is fraught with the manifestation of symptoms periodically throughout life. Unpleasant, but not fatal. True, in some cases it knocks out so much from the usual life that it leads to the appearance of disability.

The most unpleasant complication is heart failure. A person is not only tormented by a number of symptoms, but also there is no way to live as before. It is depressing. In some cases, death occurs. Therefore, hoping that the problem will go away by itself is at least silly. This is especially true for pregnant women. If symptoms appear, you should immediately inform your doctor about it. After all, disruptions in the development of the child are possible, which will lead to the appearance of pathologies. Problems with blood circulation are not excluded. This is all very serious. The doctor observing the patient must know everything about her condition, so that later she does not have to worry about the consequences.

Arrhythmia diagnosis during pregnancy - what to do

A cardiologist should treat rhythm disturbances during pregnancy. Individually, each expectant mother is selected a set of medications that need to be drunk regularly. In case of a lack of trace elements, vitamin and mineral complexes are prescribed. It is imperative to ensure complete emotional peace of the pregnant woman, the woman should walk a lot and eat right.

When the first symptoms of depression appear: a sharp increase in body weight, the appearance of age spots, frequent mood swings, a psychologist's consultation is needed. To normalize the mental state of the expectant mother, valerian and motherwort preparations are prescribed, trips out of town or rest in warm countries will be useful.