Palpitations during and after pregnancy,

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Submitted by Dr T on January 14, 2013 – 1:57pm

I am a 41 year old female suffering from gradually worsening cfs for 10 years now. Lately, I have difficulty breathing and distended stomach (otherwise fit, 5’3″ with 127 lb), swollen lymphs under arms and in the groin area and no energy whatsoever. Getting up the stairs drains me completely and I tend to sleep 17 hours a day if possible.17 years ago I was given prolonged IV medication to prevent miscarriage. I got tachycardia and was told it might damage my heart permanently. The tachycardia changed into “extrasystolic beatings” day and night. I had to be given shots to sleep and calm my jumping heart. Those episodes changed gradually into my today’s condition: no energy,  BP of 90/54, pulse 56 or less, pressure in my diaphragm causing difficult breathing, falling asleep at work or behind wheel. I am currently taking Niacin as it used to wake me up and keep me alert… Not even that anymore. I am still sleeping. Cardio stress-test didn’t increase my BP more than 120/70 and the dr says it’s perfect. What do you think?

Hi Tanya,

I am not convinced your cardiac evaluation is complete, because some of your symptoms are consistent with heart failure. There is a test that calculates your ejection fraction, but that test doesn’t always all questions of cardiac function. I specifically think of some forms of cardiomyopathy, called restrictive cardiomyopathy, or another condition called pulmonary hypertension.

I also miss information about a final evaluation of these “tachycardias” and “extrasystolic beatings“. The fact you were treated with IV meds for control, suggests there was a real problem. You should ask your doctors to review your medical records from that time to make sure there your palpitations and arrhythmias were not serious and disappeared when you delivered your baby.

Here are some common tests used to evalaute a pregnant patient with an arrhythmia:

This should be considered an integral part of the investigation of any pregnant patient with proven arrhythmia to diagnose structural and functional disease.

This can be reasonably carried out during pregnancy providing exercise is not contraindicated for obstetric reasons. Care should be taken not to exceed the woman’s normal exercise capability and the test should be stopped if hypotension develops as this may impair placental perfusion.

While there has been experience of this in pregnancy, it is usually possible to delay this investigation until after pregnancy. It is also difficult to do beyond 24 weeks as women are unable to lie flat on their backs as the gravid uterus impedes inferior vena cava flow.

  • Pharmacological testing   

A pharmacological challenge may provide important diagnostic information, particularly in narrow complex tachycardia.

  • Electrophysiological studies       

This is rarely required in pregnancy as the arrhythmia can usually be managed pharmacologically until after delivery.

If it is not your heart, swollen lymph glands, fatique and a severely decreased exercise tolerance can point to other illnesses. This is something you should discuss with your doctors.

Hope this helps,

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