Experiencing a heart attack during pregnancy is a relatively rare event, but the risk has shown an increase. One study noted a 25% rise between 2002 and 2014 in heart attacks occurring during pregnancy, labor, or the weeks following birth. While uncommon, a heart attack during this period is a serious medical event requiring immediate attention.
Why Pregnancy Increases Heart Attack Risk
Pregnancy causes significant physiological changes that increase demands on the cardiovascular system. Cardiac output, the amount of blood pumped by the heart, increases by 30% to 50% above pre-pregnancy levels, beginning early in the first trimester and peaking around 16 to 28 weeks. This increase is achieved through a rise in both stroke volume and heart rate, with heart rate increasing progressively by 10 to 20 beats per minute throughout pregnancy, reaching its peak in the third trimester.
Total blood volume also expands by as much as 45% above pre-pregnancy levels, primarily due to increased plasma volume. Simultaneously, systemic vascular resistance, the resistance the heart must overcome to pump blood, decreases by 25% to 40%. These normal adaptations can reveal underlying heart conditions or create new challenges.
Certain pre-existing conditions or complications during pregnancy can further elevate heart attack risk. Preeclampsia, characterized by high blood pressure and organ damage, is linked to a higher likelihood of heart attack. Women with a history of preeclampsia are up to four times more likely to have a heart attack within 10 years of delivery. Gestational diabetes, high blood sugar that develops during pregnancy, also increases the risk for heart attack and stroke. Studies show women with a history of gestational diabetes have a 43% greater risk of heart attack and stroke.
Spontaneous coronary artery dissection (SCAD), a tear in the artery wall, is a common cause of heart attack during pregnancy, accounting for over 40% of cases.
Identifying Heart Attack Symptoms During Pregnancy
Recognizing heart attack symptoms during pregnancy can be challenging, as some signs overlap with common pregnancy discomforts. Classic symptoms include chest pain or discomfort, often described as pressure, tightness, or a squeezing sensation, which may last for more than a few minutes or come and go. This pain can spread to the arm, back, neck, jaw, or stomach.
Other symptoms include shortness of breath, cold sweats, nausea, and lightheadedness. While fatigue and mild swelling are common in pregnancy, any new or worsening chest pain, severe shortness of breath, or a rapid, unusual heartbeat requires immediate medical attention. It is important not to dismiss these symptoms, as prompt evaluation can lead to early diagnosis and treatment.
Diagnosis and Treatment Approaches
Diagnosing a heart attack in a pregnant individual considers both maternal and fetal well-being. Healthcare providers use diagnostic tools like an electrocardiogram (ECG) to assess heart activity. Blood tests measure cardiac enzymes, which are released when heart muscle is damaged.
Imaging, such as an echocardiogram, is also used. An echocardiogram is a safe tool during pregnancy, as it uses sound waves and avoids radiation exposure. It assesses heart structure and function. In some cases, angiography may be considered to visualize coronary arteries, with precautions to minimize fetal radiation exposure.
Treatment balances maternal and fetal health. Medications commonly used for heart attacks, such as antiplatelet drugs, beta-blockers, and nitroglycerin, may be adapted for pregnant patients. In situations where a blocked artery is the cause, procedures like angioplasty, which involves inflating a balloon to open the artery, or stenting, which places a small tube to keep the artery open, may be necessary. These interventions are performed with careful consideration of the patient’s specific needs and fetal monitoring.
Reducing Your Risk Factors
Managing existing health conditions and adopting healthy lifestyle habits can help reduce the risk of a heart attack during pregnancy. Maintaining a healthy weight, engaging in regular physical activity as advised by a healthcare provider, and avoiding smoking are important measures. For individuals with pre-existing conditions like high blood pressure, diabetes, or high cholesterol, diligent management is crucial, ideally before conception and throughout pregnancy.
Comprehensive prenatal care is important for identifying and addressing heart health concerns. Open communication with healthcare providers about personal and family medical history, including previous pregnancy complications like gestational diabetes or preeclampsia, is essential. These conditions can serve as early indicators of future cardiovascular risk. Adopting a heart-healthy diet rich in fruits, vegetables, whole grains, and lean proteins also contributes to cardiovascular well-being during pregnancy.