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.