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Preeclampsia Associated W/ Persistent Postpartum Cardiovascu

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Expand view Topic review: Preeclampsia Associated W/ Persistent Postpartum Cardiovascu

Re: Preeclampsia Associated W/ Persistent Postpartum Cardiov

Post by meghanjs » Fri Aug 02, 2013 06:25 am

My younger, female PCP sent me to cardiology after my OB did not. He (an older, wise ex NICU cardiologist) did three ECHOs on me over the year or so I saw him. The second one showed a very small PFO (which is in about 20% of the population), but we sort of decided to ignore it. However, we talked about the hypercoagulable state of pregnancy and how yes, clots can be thrown through the PFO, and if I already have an increased chance of stroke or MI in the next 8 years, that maybe we ought to be concerned if there would be a future pregnancy (undiagnosed pre-E at 26 weeks, delivered severe pre-E with liver enzyme bumps at 36 weeks). Fast forward to a bit over two years after delivery and about a year after stopping my post partum pre-E labetalol, and I had a hypertensive crisis. I took labetalol before I was able to get a call back from the on-call cardiologist (thankfully I held onto it, despite knowing I should clean my cabinets) for a week, saw him several more times and even had a stress test done. His plan if we choose to get pregnant again, was to see him at the end of the first trimester, but if we go the pregnancy route again, I will probably see him prior to pregnancy just to make sure we are on the right track. By the way, I am a runner who used to be 90/60 or less (ran 20 miles a week until the 26 weeks point that I got sick) and am again running longer distances (up to 10 miles at a time, but usually 4-7). My blood pressure - no meds - has now never been below 110/74, so my guess is that yes, the litmus test of pregnancy has shown me my true colors, and probably hurried along any damage that would have eventually been done. There is a maternal side family history of hypertension and MI and stroke, but no pre-E - however, I was by far the oldest to spit out a child - 35 compared to 29 I think. Also, I am pretty sure I had post partum pulmonary edema, but was too tired and still sick to even realize what was going on, so my left ventricle, although essentially fine on ECHO later, probably was also showing it was not happy.

Re: Preeclampsia Associated W/ Persistent Postpartum Cardiov

Post by laura681 » Mon Jun 10, 2013 07:51 am

I've been having persistent low BP and some chest tightness/twinges over the past 6 weeks and my PCP has ruled out Sheehan's syndrome and every other thing she could think of. Next stop for me is the cardiologist. I'm 35 and had HELLP with liver rupture at 32 weeks in 2008 and post-partum preeclampsia in 2011. I have no history of heart disease in my family and I don't fit the normal heart disease "profile" other than having low HDL.

Has anyone else experienced anything cardiac related a few years after having preeclampsia or HELLP? I know that I have a higher risk, but I'm having trouble finding anyone who has actually had heart disease.

Any tips on what to say when I meet with the cardiologist? I'm planning on giving him a full history of my pregnancies and taking a copy of the brochure that's here on the website. What should I ask/push for?

Re: Preeclampsia Associated W/ Persistent Postpartum Cardiov

Post by alviarin » Fri Mar 30, 2012 01:51 am

My mother-in- law had preeclampsia with both her pregnancies (including my husband). Many years later she was diagnosed with chronic hypertension and hypothyroidism. She's not overweight but was a smoker for a long time which could have contributed, plus has a family history of heart disease. Her heart is ok though now she has regular checkups with a cardiologist.

My paternal grandmother had pre-e with my dad and late in life was diagnosed with hypothyroidism and lupus. ETA: She did pass away due to a heart attack/congestive heart failure- but not until she was bed bound due to illness plus it was 67 years after devloping "toxemia" and "jaundice" in her first pregnacy.

I became a chronic hypertensive after my second pregnancy five years ago. Seven years after my first bout of preeclampsia. I am overweight though and there is a family history of heart disease on my mothers side. My grandmother had hypothyroidism & congestive heart failure (even subclinical hypothyroidism can increase cardiovascular risk factors) and my grandfather was a chronic hypertensive for decades.

Re: Preeclampsia Associated W/ Persistent Postpartum Cardiov

Post by eleni » Thu Mar 29, 2012 06:41 am

Turning up the temp a bit on this issue as we're working with several organizations and investigators to figure out how we should be counseling our preeclamptics for long term health (besides of course, our nifty patient education brochure which has gotten lots of thumbs up from experts)...

so my question is have any of you had your babies long enough ago (say more than 5 years ago) and are NOW dealing with any kind of heart health issues? Do you know anybody who fits the bill and perhaps does not have all those other lovely risk factors such as family history?

Re: Preeclampsia Associated W/ Persistent Postpartum Cardiov

Post by jean » Wed Mar 07, 2012 08:51 am

JScruggs-please do let us know!

I had an EKG after my first pg, but that turned out normal. Can a heart doctor do an x-ray of some sort to look at the left ventricle of the heart to see if it was affected?

Re: Preeclampsia Associated W/ Persistent Postpartum Cardiov

Post by JScruggs19 » Sun Mar 04, 2012 10:37 am

I went through HELLP with my son in November of 2010. Prior to my pregnancy I had always had heart palpitations, but I would get them just once in a while. A few months after his birth, after I was off the labetalol and nifedipine I was placed on, my heart palpitations returned, but instead of a few a year it was more like a few a month. So finally last month I saw a doctor about it. He did an EKG which was all normal except for my lack of a p-wave. So then I wore a heart monitor for several weeks and recorded my experiences. It seems I am experiencing inappropriate sinus tachycardia...the p-wave thing I am not so sure about...perhaps a junctional rhythm thing, but I don't have all the answers just yet. Anyways, I had not been connecting the HELLP with the tachycardia episodes until now, but I am thinking they are related. My blood pressure returned to normal completely, and yet I had to start on labetalol again to control the palpitations. The inappropriate sinus tachycardia doesn't seem to be anything terribly serious, fortunately, but I am not sure what it means about my health 10-20 years down the line. As I get more answers, I will let you know just in case it can help anyone with any questions they may have.

Re: Preeclampsia Associated W/ Persistent Postpartum Cardiov

Post by caryn » Sat Mar 03, 2012 10:57 am

It's asymptomatic, which means that whether or not your pressures are high, you have a kind of early heart failure. Whether or not that's something that should be screened for if you're asymptomatic and following proactive recommendations, I do not know.

Re: Preeclampsia Associated W/ Persistent Postpartum Cardiov

Post by jean » Sat Mar 03, 2012 10:36 am

Is it still an issue if the person never develops high bp again?

Re: Preeclampsia Associated W/ Persistent Postpartum Cardiov

Post by caryn » Sat Mar 03, 2012 04:08 am

PE causes the heart issues, possibly because we are predisposed to develop them. The form is basically "busted left ventricle" because of the higher pressures we sustain, from what I can tell. It says At 1 year postpartum, asymptomatic left ventricular moderate-severe dysfunction/hypertrophy was significantly higher in preterm preeclampsia (56%) compared with term preeclampsia (14%) or matched controls (8%; P values <0.001). The risk of developing essential hypertension within 2 years was significantly higher in both preterm preeclamptic women and those with persistent left ventricular moderate-severe abnormal function/geometry.

So over half of us have *persistent* - which means it stuck around postpartum - left ventricular hypertrophy, which means the left ventricle had to work hard, got bigger, and created functional problems with how the heart pumps blood.

Re: Preeclampsia Associated W/ Persistent Postpartum Cardiov

Post by mom41 » Sat Mar 03, 2012 12:16 am

I believe pre-e is a risk factor for peripartum cardiomyopathy - form of congestive heart failure, usually temporary. It seems like pre-e accelerates/unmasks htn. I had an EKG and Echocardigram done and was able to reach almost my baseline exercise capacity by re-joining the gym after my pre-e pregnancy. I see a cardiologist for chronic htn once a year. He did not feel I needed a stress test or anything else.

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