Heart Palpitations During Pregnancy
It can feel like a fluttering in the chest, a racing, pounding or fast-beating heart. Sometimes it comes and goes quickly without garnering much attention, but in other instances heart palpitations can be very noticeable -- and scary.
"Palpitations are actually a rather subjective sensation, in that everyone may feel it slightly differently," explains Dr. Nathaniel Smilowitz, an interventional cardiologist and assistant professor of medicine at NYU Langone Health in New York City.
Exactly how many people experience heart palpitations, or how prevalent they are, isn't entirely clear. That's because they often go unnoticed or those who experience them don't know what they are. But experts note that they occur frequently, in general, and even more so in pregnancy. "Palpitations are very common in pregnancy," Smilowitz says.
What Are Heart Palpitations?
Heart palpitations are a feeling or sensation that, in many instances, may just reflect the normal variations of a working heart. Sometimes the heart races or skips beats, and the reasons for this vary and in many cases are unknown. Often the palpitations last only a few seconds. It happens out of the blue but doesn't recur. Less commonly, palpitations may persist for longer periods or occur on a regular basis, and occasionally they can be a sign of a more serious issue like an arrhythmia -- a problem with the rate or rhythm of the heartbeat.
[See: 10 Weird Mind and Body Changes That Are Totally Normal During Pregnancy.]
Grayver says heart palpitations are one of the most common complaints she hears about from patients who are pregnant, right after shortness of breath. Even so, while typically benign, she and other clinicians caution against dismissing the concern out of hand.
If you have other symptoms that accompany heart palpitations, including shortness of breath, lightheadedness and the sensation that you're about to pass out, or if you actually do faint or briefly lose consciousness, seek immediate medical attention. "All of those are red flags that require urgent evaluation," Smilowitz says.
Even in the absence of accompanying symptoms, for anyone who has concerns about palpitations, experts say, it's important to let your health provider know to determine if further action should be taken.
Cause
Although it's not entirely clear why palpitations are more common during pregnancy, clinicians say normal yet profound hormonal and physiological changes that happen during those nine months likely play a role. That includes an increase in blood volume of 30% to 50%, as much more blood is pumped to the uterus, and a raised heart rate, from a normal prepregnancy rate of about 70 beats per minute to 80 to 90 beats per minute, according to Merck Manual, a medical resource. Taken altogether, "your heart is working harder during pregnancy," says Dr. Adam Lewkowitz, an assistant professor of maternal-fetal medicine at Brown University and maternal-fetal medicine specialist at Women & Infants Hospital of Rhode Island.
Risk Factors for Palpitations During Pregnancy
A variety of factors may increase a person's cardiovascular risk and chances of having heart palpitations during pregnancy. Those include:
-- Age, particularly if 35 years or older when pregnant.
-- Existing heart defects.
-- Cardiomyopathy, a disease that makes it harder for the heart to pump blood.
-- Family health history, like a parent or close relative who has an arrhythmia.
-- Lifestyle habits, including drinking, smoking or using drugs such as cocaine.
-- Preexisting high blood pressure or the development of high blood pressure during pregnancy, aka preeclampsia.
-- Diabetes or low blood sugar.
-- Autoimmune disorders like lupus.
-- Obesity.
-- Other medical conditions, ranging from flu to sleep apnea.
Many women today are now waiting to get pregnant until later and some have more cardiovascular risk factors when they do, like high blood pressure or diabetes, experts say. What's more, treatment of congenital heart defects -- those defects present at birth -- has greatly improved. As a result, many people with congenital heart defects are living longer, fuller lives -- and starting families of their own.
"We're seeing a lot of people that have had congenital disease -- cardiovascular diseases that they were actually born with -- now getting pregnant," says Dr. Evelina Grayver, a cardiologist who specializes in high-risk pregnancies and director of the coronary care unit at North Shore University Hospital in Manhasset, New York. "And we have to be a little bit more cautious about that as well."
[See: How to Eat Vegan During Pregnancy.]
Diagnosing Underlying Medical Conditions
In the absence of other symptoms, it's still important to discuss concerns about heart palpitations with your doctor. Often in addition to a history and physical evaluation, an electrocardiogram, or EKG, may be ordered to briefly record electrical activity associated with your heartbeat. To supplement that snapshot, you may also be advised to wear a cardiac monitor, usually for a period of time ranging from 24 hours to a week.
"In the past, it used to be a humungous nuisance for anybody who's pregnant," Grayver says -- requiring patients to carry a device akin to "a big old-school pager" with wires to boot. Although sometimes relatively bulky monitors are still used today, modern monitors tend to be smaller and more seamless. "The monitors literally look just like a small Band-Aid that goes over your chest. You can shower with it, you can swim with it, do anything and everything with it; and it continuously records your heart rhythm," Grayver says.
Cardiac monitoring can help in diagnosing a serious arrhythmia like atrial fibrillation or other heart problems. Experts say proper diagnosis is key to managing the condition and preventing complications like stroke or sudden cardiac arrest, in which the heart suddenly stops beating.
In addition, bloodwork may be done to ensure a metabolic issue, like an underactive or overactive thyroid gland, isn't to blame. A blood test may also reveal a decreased red blood cell count indicating an iron deficiency called anemia. A common issue during pregnancy, anemia can cause palpitations as well.
Lifestyle Changes to Reduce Palpitations
Experts say for those who never experienced heart palpitations before pregnancy and where there's no serious underlying cause, the palpitations often resolve on their own.
Even so, clinicians say it's important to address risk factors whenever possible. That includes abstaining from smoking, illicit drugs of any kind and alcohol consumption during pregnancy. "There is no known safe amount of alcohol during pregnancy or when trying to get pregnant," according to the Centers for Disease Control and Prevention. Also, ensure that other health conditions like diabetes and high blood pressure are well-controlled.
[See: 6 Drugs That Can Worsen or Increase Risk for Heart Failure.]
Additionally, these lifestyle changes may also help reduce palpitations:
-- Avoid heavy meals, instead opting for more frequent, smaller meals.
-- Do everything you can to get adequate rest.
-- Limit caffeine intake.
-- Manage stress and anxiety with meditative activities like yoga.
While there's conflicting research on caffeine -- and, in particular, how much is safe to consume -- the March of Dimes suggests having no more than the equivalent one 12-ounce cup of coffee per day during pregnancy.
The good news is that for the majority of women who experience palpitations during pregnancy, it has no significance for either how their pregnancy will go or their long-term health, Lewkowitz notes. "But because it can be a new symptom, it's something that they need to let their doctor know about," he says, "so that we can evaluate them and decide how much additional workup is needed."
