Preeclampsia Associated W/ Persistent Postpartum Cardiovascu

[caryn]

http://hyper.ahajournals.org/content/58/4/709.short

The majority of preterm preeclamptic women have stage B asymptomatic heart failure postpartum, and 40% develop essential hypertension within 1 to 2 years after pregnancy. Women with a history of preterm preeclampsia may benefit from formal cardiovascular risk assessment in the 1 to 2 years after delivery to identify those who would benefit from targeted therapeutic intervention.

Have you had a formal cardiac workup? I'm thinking I need one.

[alviarin]

I did after my second round of preeclampsia and my blood pressure never quite came back down to my pre-pregnancy baseline. I went to the cardiologist and my heart checked out ok. My HDL levels are low though.

Since I'm hypertensive I'm on a low dose of BP meds to help lower my long-term risks.

[kerisue]

I didn't just have asymptomatic postpartum heartfailure, I had symptomatic heart failure during the pregnancy! My heart has since returned to normal, but my primary care doc has been very reluctant to do any more aggressive testing/treatment for cardiovascular disease. I'm guessing she is not up to date on this research, but I may push it a bit more now.

[caryn]

I'm not entirely sure what to think about more screening, actually. We're already known to be at high risk of heart disease, and if it's asymptomatic but we're already doing the things we're supposed to be doing to strengthen our hearts and manage our existing risks, then I'm not sure a screening test would provide more information. I wonder if there would be anything we would do differently if they did an echo and found something, or if it would just be an expensive test that says yep, you're still supposed to get more exercise and keep your weight down...

[sam10]

I never quite found more detailed information about the type of cardiovascular disease that PE ladies are at risk for. Any reference I have found usually just mentions that women who have had PE are at higher risk for cardiovascular diseases. Is there any more info available on that?

[JB]

My OB just had me get an EKG, but I haven't gotten the results yet. She is very cautious and has had me get every test imaginable to get a baseline of my health for this pregnancy, in case I develop PE again. She ordered it when she realized my nephrologist hadn't ordered one yet. I was seeing a nephrologist instead of a cardiologist for my post-PE hypertension care because I only have one kidney and need to have it checked out once a year anyway, but now my OB is managing all my care. My mom jokes that she is only ordering all these tests because I have insurance that will pay for them, but they do make me feel better (at least I know she is taking it seriously).

[jean]

So my question is, does the pre-e cause the heart issues, or do the heart issues cause the pre-e?

[mom41]

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.

[caryn]

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.

[jean]

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