Heart goes "thump-thump". I want mine to keep doing that.

August 13, 2008 4:07 PM

How will family history of heart problems affect my prenatal care?

I know YANAD, and YANAC (Cardiologist).

I am a 30 yr old woman, happily about 7 weeks pregnant with my first child. I have my first prenatal appointment in 10 days, and have been wondering what the appointment will be like given my medical history of heart problems.

My father has a heart murmur, and his mother died in childbirth due to an undiagnosed heart murmur. High blood pressure, heart attacks all over that side of the family.

My mother, along with almost all of the women on that side of the family, has mitral valve prolapse, of varying degrees of severity. I've never been diagnosed with MVP--though I've also never been checked for MVP. I suspect I've got it.

In addition, I've got vasovagal syndrome--unexpected pain makes my blood pressure shoot up and I usually pass out.

Taken on an individual basis, I believe these things are minor. However, when they are combined in a body that is also trying to gestate a living thing with increased blood volume and load on my heart.....the thought that I could drop dead during childbirth has crossed my mind.

I know the first prenatal appointment will include a detailed medical history, and I plan on mentioning these things...I'm just wondering what I might expect? Cardiology work-up? Extra monitoring?

I'm mostly asking because I don't want to be shocked IF my OB orders extra tests, etc., due to my history.

posted by anonymous to health & fitness (6 comments total)

not a doctor, but i would imagine that yes, you can expect some or all of those things. i think it's normal to be worried about all sorts of crazy things, but a good doctor should be able to address all your concerns to your satisfaction.
posted by thinkingwoman at 4:52 PM on August 13, 2008

I'm in my late 30s, have MVP, and a possible predisposition to aortic aneurysm (combined, unluckily enough, with hemophilia). My cardio told me last year that if I were to get pregnant, he'd just ask me to come in on a regular basis (probably monthly) for echocardiograms, though I suspect that my being over 35 and have the possible aneurysm risk (plus: bleeder!) are bigger factors than the MVP alone.

I can't tell from your post if you've had cardiac workups before or not. If not, and given that you have a family history of heart murmur, I don't think it would be either surprising or alarming if they send you for an echocardiogram. It's basically the same ultrasound device they use to see the fetus; they just run it over your chest instead of your belly.
posted by scody at 5:28 PM on August 13, 2008

sorry, just realized you said this:
though I've also never been checked for MVP
...so I guess that answers my question as to whether you've had a cardiac workup before.
posted by scody at 5:29 PM on August 13, 2008

My father has a heart murmur, and his mother died in childbirth due to an undiagnosed heart murmur. High blood pressure, heart attacks all over that side of the family.
.My mother, along with almost all of the women on that side of the family, has mitral valve prolapse
..I've got vasovagal syndrome
...I know the first prenatal appointment will include a detailed medical history, and I plan on mentioning these things...I'm just wondering what I might expect? Cardiology work-up? Extra monitoring?

Yes. These things would be concerning to your physician, and she will probably want to check in more closely on both your heart and your baby's, once that is possible. The exact things that your physician will want to do are hard to say without a thorough history and physical, so I won't mislead you by guessing.
posted by a robot made out of meat at 6:36 PM on August 13, 2008

Your history does suggest higher risk for a heart defect. Though I am not a physician, my father is, and it just so happens that he specializes in adult congenital heart disease (ACHD), a cardiologist who has specialized in patients with congenital heart defects, e.g. murmurs, MVP, ASDs, etc. who survive into adulthood. It's a small but growing practice area.

You shouldn't be surprised if your OB recommends a cardiology workup, and if he does, I'd recommend looking for a specialist in ACHD. I'd go for it even if he doesn't; if you may have undiagnosed heart defects, you need to resolve those issues definitively anyways.

The Adult Congenital Heart Association has a list of hospitals/clinics with ACHD practices. I'd recommend getting in touch with one, even if only to get a clean bill of health. Insurance carriers are usually glad to pay for these sorts of workups, as managing the disease while largely asymptomatic is significantly less costly than dealing with acute ailments. Fortunately, many patients can be cured entirely.

You may have to drive quite a ways to get to one of these clinics, but it's worth it. My father has numerous patients who drive 3 or 4 hours every six months for their routine checkups. Unlike most cardiologists, a significant number of his patients are in their 20s and 30s, and any ACHD specialist will be completely used to managing the care of pregnant women. I can't recommend seeing one enough.
posted by valkyryn at 5:52 AM on August 14, 2008

One of my good friends has heart problems similar to yours and had to have a C-section, no question. Her OB would not even consider letting her deliver vaginally. Apparently it was too big of a risk.
posted by FergieBelle at 2:38 PM on August 17, 2008