Pregnancy and postpartum can take a toll on your cardiac health. Women across Westwood, Brentwood, Santa Monica, and Beverly Hills have access to the top hospitals for maternity care that Los Angeles has to offer, but there are things that get left out. More than likely, you know that pregnancy taxes your cardiovascular system and those implications can last a lifetime. Dr. Maria Tehrani, cardiac surgeon at Ronald Reagan UCLA Medical Center in Westwood, has caring for patients in their 40s and 50s whose heart disease is a result of complications from their pregnancy that occurred many years earlier. If you can see this connection earlier, it gives you decades of opportunity to protect yourself.

Pregnancy Is Like a Cardiac Stress Test

Throughout pregnancy, the body is experiencing volume increases of up to 50%. The heart does not take a break. Blood vessels dilate. The body prepares to clot. Without a doubt, common sense suggests that if you tax your body in this way, it is your heart that does the work. That said, through pregnancy, you may have an undiagnosed heart condition.

Pregnancy Is Like a Stress Test

Most people, including all doctors, describe pregnancy as a natural stress test. Women who have a complication may be the first to know about their heart issue, while women who get through unscathed have been given a great gift about the state of their heart.

Preeclampsia and Gestational Hypertension Are Long-Term Signals

These women are commonly told that their high blood concerns will all resolve once they deliver, but that is not the case. These conditions are not without cardiovascular implications, and should be treated with an incredible level of seriousness after your child is born.

Although there have been numerous changes to improve outcomes for pregnant and postpartum women, cardiovascular implications still persist. For example, women who developed preeclampsia have twice the lifetime risk of developing heart disease and stroke compared to women who did not. Gestational diabetes also presents an additional risk of inducing type 2 diabetes which is also highly related to coronary artery disease. There is also an additional risk with delivering a baby pre term and having a baby with low birth weight.

None of these may sound good, but it also does not mean heart disease will happen. It may be important to put these women into a high-risk group for blood pressure, cholesterol, and glucose testing some time in their 30s rather than their 50s. But often this is not documented anywhere in their records. So if you have had any of the above complications, let your physician know every time – your primary care physician, your OBGYN, and even your cardiovascular physician.

Peripartum Cardiomyopathy

Peripartum cardiomyopathy is a pregnancy related heart failure diagnosed in the last month of pregnancy or the following months. This causes a loss of the heart’s ability to pump. While it is rare, it is important to note that women of older maternal age, women with preeclampsia, and women of the Black race have an increased incidence of this, as well as poorer outcomes.

Signs and symptoms include: shortness of breath when lying flat, swelling of the legs and feet, a fast or irregular heartbeat, nighttime coughing, and extreme fatigue. Each of these symptoms can all be explained by the typical recovery of a new mom and the irregular sleep cycle and rest the body is currently recuperating from. That is what makes this condition dangerous. If caught early, many women see a notable recovery in their heart function. However, if caught too late, some can proceed to advanced heart failure.

When Postpartum Depression and Heart Symptoms Coincide

Postpartum depression occurs in approximately 1 in 8 newly attending mothers, and there has been an especially large amount of focus to diagnose and treat this depression, which has been very positive. This has caused a blind spot in care, which is worth discussing.

The symptoms of postpartum depression and peripartum cardiomyopathy include: exhaustion, shortness of breath, chest tightness, rapid, fast heart, irregular pulse and rest disruption. When a mother lacks these symptoms, care is more focused on the mental side, and evaluation of their heart is often neglected. Some mothers are told they have anxiety, when in fact they have heart failure.

The focus of treatment of depression should not be questioned. It should always be addressed. The two conditions can coexist. Peripartum cardiomyopathy also heightens a new mother’s risk of developing cardiovascular disease, and should be treated simultaneously.

A simple standard is attractive. If a postpartum woman describes breathlessness, swelling or palpitations, then it is easy and cost efficient to perform a blood pressure check and echocardiogram to resolve it. If you are having emotional issues postpartum, then please inform your obgyn or doctor, and request that it is checked along with your heart. It is important and warrants assessment.

Protecting Your Heart After You Deliver

The 6 week postpartum period draws the most amount of medical attention, then women have considerably less contact with the medical system. For women with high risk pregnancies, this is a problematic gap.

Have your blood pressure checked many times in the first few weeks post delivery, then again at 3 months and again at 6 months. Have your cholesterol level checked plus your sugar/glucose level and HbA1c check within the 1st year. Make a primary care appointment and see a doctor who will record your complete pregnancy record. Return to exercise with your obgyn cleared you all good. During the postpartum period if you smoke or vape then this is a great opportunity to quit.

For moms on the Westside trying to run school, work and the household as well, these appointments are challenging to fit in the schedule. However, they are valuable and important.

When to See a Cardiac Specialist

Shortness of breath at rest or on lying flat, swelling of your legs/ankles which doesn’t resolve, chest pains, pressure or discomfort, heart racing or heart palpitations, passing out, and overwhelming fatigue even with the normal newborn tiredness are all postpartum issues that need assessment. These are reasons you need a cardiac specialist regardless of the length of time since you gave birth.

You may also consider a cardiac consultation even if you currently have no symptoms. This may be necessary if you had gestational hypertension, preeclampsia or gestational diabetes, or were diagnosed with peripartum cardiomyopathy in a previous pregnancy. A cardiac consultation is also suggested if you have a heart condition and are pregnant, or if you have a family history of heart disease at an early age with a complicated pregnancy.

Dr. Tehrani assesses patients in the greater Los Angeles area for pregnancy-related cardiac conditions and provides pregnancy planning consultations to cardiac patients. An early cardiac assessment provides patients with the most options and greatest flexibility.

Maria Tehrani, MD Cardiac Surgeon

Ronald Reagan UCLA Medical Center
Phone: 818-350-9899
Email: welcome@mariatehranimd.com
Address: 757 Westwood Plaza, Los Angeles, CA 90095
Hours: Monday–Friday, 9AM–5PM
Westwood, Brentwood, Beverly Hills, Santa Monica, Century City, Bel Air, Pacific Palisades, Marina del Rey, and Culver City