Dr Swapnil Mate Cardiologist

The physiological changes that occur during pregnancy are:-

Nausea - Morning sickness can strike at any time of the day or night. To avoid this, the individual must avoid being on an empty stomach. The pregnant individual must avoid foods that are rich in fats.
Increase in urination - The pregnant mother might urinate more often than usual. This is because, during pregnancy, the body produces more blood for the fetus. This makes the kidneys produce more fluids that end up in the bladder.
Fatigue - The pregnant mother might feel sleepy during the first trimester due to an increase in blood volume and the hormone progesterone.
Hunger - The pregnant mother might experience increased levels of hunger because the growing fetus needs nutrition for its development. Hunger felt during the second and third trimesters is felt because of the secretion of milk from the mammary glands, called lactation.
Heartburn - Since the hormone progesterone causes the heart valves to relax, it increases the frequency of heartburn. Acid reflux can take place when the valve and the esophagus are unable to prevent the stomach acids to flow back to the esophagus.
Constipation - Progesterone relaxes the smooth muscles of the body. This reduces the ability of the digestive tract to digest food in the stomach, leading to constipation.
Swollen Breasts - During pregnancy, the breasts of the pregnant mother swell up because the hormone estrogen enhances the growth of breast ducts and progesterone helps in the growth and formation of milk-producing cells

The cardiac changes during pregnancy are:

High blood volume - during pregnancy the blood increases by 40 or 50 percent.
Cardiac output - the amount of blood pumped by the heart each minute is called the cardiac output. This increases during pregnancy by 40 percent.
Heart rate - the heart rate increases by 10 more beats per minute during pregnancy.
Blood pressure - the blood pressure decreases since the blood is directed towards the fetus.

Diseases And Disorders That Affect Pregnancy

The diseases and disorders that affect the gestation period are

Arrhythmia - is a condition referring to abnormalities in heartbeats due to issues in the electrical conduction system of the heart. When the heart beats too slow, it is known as bradycardia, and when beats too fast, it is known as tachycardia. In some cases, arrhythmia arises with no symptoms. Symptoms, if present, may include shortness of breath, palpitations, chest pain, sensing a pause between heartbeats, blackouts, etc. In a few situations, it may even lead to heart failure or sudden cardiac death.
Hypertrophic Cardiomyopathy - this type of cardiomyopathy is an inherited cause. Hypertrophic cardiomyopathy is a genetic disorder where the mother, having that mutation in the genes, passes the same genes to her offspring. Another cause of this disorder is Fabry Disease, which is a genetic disorder caused due to the absence of an enzyme called alpha-galactosidase A. This leads to substances build-up in the walls of the coronary arteries and also affects the kidneys and skin. Another genetic disorder that contributes to hypertrophic cardiomyopathy is Friedreich's Ataxia, where there is a mutation in the gene that makes a protein called frataxin. This disease causes loss of sensation in arms and legs and difficulty in a speech that worsens over time. Symptoms of hypertrophic cardiomyopathy include fatigue, swelling of legs, shortness of breath, chest pain, etc.
Arrhythmogenic Cardiomyopathy - it is a type of cardiomyopathy, where the cardiac muscle does not function properly due to genetic defects in it. It primarily affects the tissues of the right ventricle, with associated irregular heartbeats. It first attacks the right ventricle, which puts a lot of stress on the left ventricle, and then, if not treated, stiffens and weakens both the ventricles. Symptoms include irregular heartbeats, blackouts, heart palpitations, etc.
Niemann-Pick Disease - this is an inherited metabolic disorder caused when the lysosomes fail to break down sphingomyelins, a type of sphingolipids, in cells. Symptoms include low platelet count in the blood, enlargement of spleen, liver, and bone marrow cavities which may cause reduced appetite, pain, difficulty in swallowing, abnormal posturing of limbs, face, slurring of speech, sleep deprivation, etc. Loss of myelin in this disorder majorly affects the central nervous system since myelin sheath assists in the speedy transmission of electrical impulses along the axon.
Fabry Disease - is a genetic disorder. The genetic mutation interferes with the function of an enzyme called alpha-galactosidase A that processes sphingolipids. This leads to substances build-up in the walls of the coronary arteries and also affects the kidneys and skin. Symptoms include pain in the gastrointestinal tract, kidney failure, presence of protein in the urine, thickening of cardiac muscle, shortness of breath, slow heart rhythms, etc.
Krabbe Disease - it is a genetic disorder caused due to mutation of the GALC gene, in which the enzyme galactosylceramidase, is encoded. This disorder gradually damages the nervous system. Symptoms involve irritation, fever, vomiting, deafness. muscle weakness, seizures, blindness, difficulty during swallowing.
Gaucher's Disease - is a disorder where sphingolipids get collected in the cells and other organs. It is characterized by the deficiency of an enzyme called galactosylceramidase, which gets accumulated in the white blood cells. This enzyme gets collected in the spleen, liver, kidneys, lungs, brain. Symptoms include enlargement of the liver, spleen, reduction in white blood cells and platelets, formation of the scar tissue in the liver, low bone density(osteoporosis).
Tay-Sachs Disease - is a genetic disorder that damages the brain and nerve cells. Symptoms include the child becoming deaf, blind, speech and sound disorder, difficulty in swallowing, etc.
Familial Cholesterolemia - a hereditary condition that reduces the liver's ability to remove low-density lipoprotein. This increases the risk of having a heart attack.
Hypoplastic Left Heart Syndrome(Hypoplasia) - is a medical condition where the left side of the fetus's heart is underdeveloped. In this syndrome, the infant is very ill and has blue skin color due to the inability of the heart to pump and transfer blood to the body.
Coarctation of the Aorta - this is a condition where the aorta, the blood vessel which is responsible for transporting blood to all organs of the body is very narrow. This might have been due to the underdevelopment of the aorta while the formation of other organs in the fetus's body.
Ventricular Septal Defect - a condition in which a hole develops in the wall that separates the lower chambers of the heart(ventricles).
Pulmonary Atresia - a condition where the pulmonary valve, the valve responsible for carrying deoxygenated blood from the heart to the lungs is not formed at all.
Ventricular Outflow Tract Obstruction - this is a condition where the arteries or ventricles are underdeveloped or abnormally narrow. Narrowing of the arteries causes hypertension.
Tetralogy of Fallot - a congenital disorder comprising of four cardiac defects, pulmonary stenosis(obstruction of blood flow from the lower right heart chamber to the pulmonary artery), ventricular septal defect, right ventricular hypertrophy, overriding aorta.
Down Syndrome - a genetic disorder caused due to the presence of a third copy of a chromosome(21). Symptoms include intellectual disability, defects in the mitral valve but they have a lower risk of suffering from a heart attack there have been fewer cases of hardening of arteries in their hearts.
Turner Syndrome - a genetic disorder caused due to a missing X chromosome. Women with Turner syndrome are unable to have children during adulthood. Symptoms include swollen hands and legs during birth, low hairline, etc.
Holt-Oram Syndrome - a genetic disorder that affects the bones and causes heart problems.
Brugada Syndrome - comes under congenital heart disorder. This is caused when the electrical signals that help the individual cells of the heart to communicate, are disrupted, leading to a genetic mutation in the person's DNA. Symptoms include blacking out and sudden cardiac death.
Wolff-Parkinson-White Syndrome - this is a medical condition caused due to an accessory pathway in the heart. An accessory pathway is an extra electrical pathway present between the upper and lower chambers of the heart. This results in rapid heartbeats, shortness of breath, chest pain, fatigue, dizziness, etc.

Risk Factors That Affect Pregnancy

The risk factors that affect the heart which, therefore, interfere during the gestation period are:-

Valvular disorders-defects in any valves of the heart can reduce the ability to transport deoxygenated blood or receive oxygenated one, leading to heart failure.
Smoking and alcohol consumption - actively smoking or consuming alcohol makes the blood sticky, and it is most likely to clot, which can obstruct the blood flow to the heart. It also lowers good cholesterol in the body.
Genes - congenital heart disorders are caused due to gene mutations in the DNA of the mother whose genes the child shares.
Rubella - Also known as German measles, is an infection caused by the rubella virus that transmits to humans via the respiratory route. If the mother has caught this infection, it might severely affect the heart and brain.
High blood pressure - High blood pressure or hypertension makes the coronary arteries less elastic, which reduces blood flow to the heart. This makes the heart work harder, causing stiffening of the heart muscle and death of the cells present in the cardiac muscle.
Cholesterol - The total number of cholesterol in the blood also affects the heart. The low-density lipoprotein transports cholesterol from the liver to other tissues and cells, which use this as energy. Low-density lipoprotein, along with triglycerides, gets deposited in the arterial wall, obstructing the blood flow to the heart.

Diagnosis

This includes:-

Obstetric Ultrasonography - is the use of ultrasound during pregnancy. A device called a transducer is placed on the top of the chest and ultrasonic waves are sent to the heart to bounce off and show the live image of the heart, using a monitor. Obstetric ultrasound is done during the early stages of pregnancy to check any fetus abnormalities or whether the fetus has come in contact with infection or heart defect.
Installation of an Artificial Pacemaker- this device generates electric impulses by the electrodes present in the device that makes the lower and upper heart chambers contract to pump blood. This device regulates the normal function of the electrical system of the heart. Its main purpose is to restore the normal rate of the heart which was either very slow or very fast earlier due to a defect in the natural pacemaker of the heart.
Intra-aortic balloon pump - used in percutaneous coronary angioplasty. It is done by placing a catheter through the blood vessel into the heart. The balloon is placed at the tip of the catheter. When it is blown, it forces the valve to open. The balloon valvuloplasty is done in mitral, aortic, or pulmonary valves.
Ventricular assist device - this device replaces the failing heart.
Heart valve replacement - the valve is replaced either surgically in case of surgical aortic valve replacement or transcatheter aortic valve replacement where a catheter is used to replace the valve.
Fetal echocardiogram test - This test is done by an experienced perinatologist or obstetrician who evaluates the fetal heart which is often not analyzed properly during a regular obstetric scanning. It is done to check whether the fetus is suffering from any disorder due to congenital heart disorders.
Minimize Procedure - this procedure is used to treat atrial fibrillation by destroying the tissue in the atria that are caused by arrhythmia. If the fetus is suffering from arrhythmia, this procedure is implemented.
Medications:
1. Allergies - Allegra, Benadryl
2. High blood pressure - Methyldopa, Nifedipine, Labetalol
3. High Cholesterol - Lipitor, to reduce bad cholesterol
4. Sleep - Benadryl, to induce sleep
5. Diarrhea - Imodium
6. Vitamins - Multivitamin tablets, Folic Acid, DHA supplements
7. Pain Reliever - Tylenol
8. Nausea and vomiting - Vitamin B-6 tablets, Dramamine
9. Constipation - Miralax, Metamucil

NOTE:- These medicines should be taken only if the patient has been recommended to take by their obstetrician or perinatologist.

The pediatric cardiology team of Dr. Swapnil Mate's Cardiology Clinic includes a group of experienced pediatric cardiac surgeons and assisting surgeons, perinatologists, obstetricians, physical therapists, nutritionists, geneticists, child-life specialists, and a group of pathologists who run by tests and give the proper cause of diseases and helps in identifying the disorders in children. The team consults with other specialists for proper examination. Together, they provide extensive care to mothers and children provide services that cater to their needs. Consult Dr. Swapnil Mate for the best medical assistance