Pregnancy & Echocardiography

Pregnancy puts increased stress on the heart and circulatory system. With this in mind, more diagnostic testing and monitoring need to be done with women who have pre-existing cardiovascular health concerns or are at higher risk for cardiovascular disease during pregnancy.

According to a recent report released by Mayo Clinic, there are approximately 7 maternal deaths for every 100,000 pregnancies. Further, 1-4% of these maternal mortalities are due to cardiovascular disease (CVD), which makes it the leading cause of pregnancy-related death. Specifically, cardiomyopathy in pregnancy is the fifth leading cause of maternal mortality.

Risk Factors for Cardiovascular Disease and Pregnancy

• If the mother is over 40 years of age the risk for CVD-related maternal death increases.
• Non-Hispanic African American women have a higher risk of dying from CVD-related pregnancy complications.
• Hypertensive disease affects up to 10% of pregnancies and increases the risk of maternal morbidity.
• Obesity increases the risk of cardiovascular disease during pregnancy.

Hemodynamics (Flow of Blood) of Pregnancy

During pregnancy, a woman’s heart stroke volume increases. A typical pregnant mother’s blood volume increases by 30-40%, and as a result, the heart pumps more blood each minute which causes a heart rate increase. These factors lead to an average of a 30% increase in cardiac output among pregnant women.

Normal ECG Test Results During Pregnancy

With Common Physiological Complications

• Increased LV dimension, volume, LV wall thickness and mass
• Mild aortic root dilation
• Increased RV dimension and volume
• Increased LA size and volume
• Increased MV E velocity (early in pregnancy, decreases later); Increased MV A velocity
• LV ejection fraction remains stable
• RV ejection fractions remain stable
• Global longitudinal strain remains in normal limits
• Tricuspid regurgitation remains the same

Common Pathological Findings:

• Cardiomyopathy
• Aortopathy
• Arrhythmias

Postpartum Cardiomyopathy

As mentioned earlier, cardiomyopathy is the fifth leading cause of maternal mortality. It can occur sometime during the last trimester or up to six months postpartum. However, it most commonly occurs during the first month after delivery. Most women who experience postpartum cardiomyopathy recover, but some are left with dilated cardiomyopathies and chronic heart failure which requires follow up.

Risk Factors for Postpartum Cardiomyopathy:

• Mother is over the age of 30
• Multi-fetal pregnancy & multiparty
• Prior history of post-partum cardiomyopathy (increases risk by 20%)
• African American mothers are at higher risk
• Hypertension; diabetes mellitus; smoker; preeclampsia

Accurate cardiac diagnosis among pregnant women is extremely important as it shows the necessity of non-invasive monitoring throughout the pregnancy and helps determine whether medical intervention is needed. Echocardiograms are safe, non-invasive and will therefore likely remain the primary tool in diagnosing and assessing disease severity and monitoring pregnant women.

Have any questions? Feel free to contact our team!

References

Connolly, Heidi M (2019). Echo Evaluation of Pregnant Patients with Heart Disease. Echo/Imaging.

New York: State of the Art 2019. Mayo Clinic Department of Cardiovascular Medicine.