Heart disease is a leading cause of maternal deaths , accounting for one in four Californians people who died within a year of giving birth.

Congenital heart disease is the most prevalent form of cardiovascular disease (CVD) in young women of child-bearing age.

Additionally, peripartum cardiomyopathy — a recently recognized condition specific to pregnancy — may occur during later stages or within first few months after delivery.

It causes the heart muscle to balloon up or become too weak to contract. It may lead to heart rhythm abnormality that usually results in shortness of breath, cough, fatigue, dizziness or fainting.

All women are potentially at risk

“While the chance of acquiring peripartum cardiomyopathy is very low, no one is immune,” says UCI Health cardiologist and maternal-fetal medicine specialist Dr. Afshan B. Hameed.

Certain individuals have a higher risk of developing cardiovascular problems in pregnancy, particularly those with underlying conventional cardiovascular risk factors, such as older age, diabetes, hypertension and obesity.

Substance abuse may also increase the risk. Still, heart disease can strike any woman, says Hameed, a national leader in studying the connection between heart disease and pregnancy.

“The biggest challenge is under-recognition of heart disease — by the patient and the provider,” says Hameed, who is also a professor of obstetrics and gynecology, maternal-fetal medicine and cardiology at the UC Irvine School of Medicine.

“That combination can be devastating.”

Early diagnosis of CVD is the key to improving maternal and neonatal outcomes, she says.

Tool kit helps providers identify at-risk women

Hameed has long worked with the California Maternal Quality Care Collaborative and as co-chair of its Cardiovascular Disease in Pregnancy and Postpartum Task Force. She helped create a tool kit to identify pregnant women at high risk of developing heart disease during and after childbirth who need further evaluation.

The tool kit is risk-assessment algorithm developed for a wide variety of generalists who provide maternity care:

• OB-GYNs
• Labor, delivery and postpartum nurses
• Nurse practitioners
• Certified nurse midwives
• Family medicine physicians
• Emergency care specialists

Creating a screening standard

Hameed is spearheading a national study of the tool kit in partnership with major healthcare systems, which are implementing and evaluating her screening algorithm.

“The aim of the study is to validate the potential of this tool to become the national CVD screening standard for pregnant patients,” says Hameed.

“This study will not only further our knowledge about the overall heart disease process in pregnant patients, it also affords us an opportunity to address the main cause of maternal mortality and improve outcomes in patients with chronic medical conditions and CVD risk factors,” she added.

Heart trouble can appear without warning

Peripartum cardiomyopathy can show up without warning during pregnancy.

There’s some thought that it may be the result of hormonal changes, but that has yet to be proven. Undetected preexisting heart conditions may also be revealed during pregnancy, when women are already in a state of low-level cardiovascular stress.

Too often, Hameed says, providers and patients dismiss warning signs of heart disease as harmless and typical of pregnancy.

In fact, the symptoms of heart disease are similar to the usual side effects experienced during pregnancy and postpartum, Hameed says. Women can experience:

• Fatigue
• Lower-extremity swelling
• Shortness of breath
• Chest pain
• Palpitations
• Dizziness

Treatment can prevent bad outcomes

If a heart condition is diagnosed early in a pregnancy, treatment can prevent bad outcomes, including death. Most of the disastrous consequences occur when the problem isn’t suspected, Hameed notes.

Treatment usually involves standard medications for heart failure. Hameed says that 50% of women will improve to the point where their hearts are normal six months after starting medication. The other half may require medication for the rest of their lives.

“Overall, the death rate is low — less than 5% — but the ones who do die are primarily the ones who remain unrecognized and untreated,” she says. “Women with preexisting heart conditions actually do better because they already have treatment plans.”

Report symptoms to your doctor

“My advice to patients is to report their symptoms — shortness of breath, chest pain, palpitations, fatigue, dizziness, lower-extremity swelling — to their doctor,” Hameed says.

“If your symptoms are affecting your day-to-day life, don’t disregard them. I recently had a patient who developed symptoms early enough, and it saved her life. Patients need to recognize when there is a problem and reach out.”