Coronary heart Murmur Throughout Being pregnant | Nicely+Good

As a mom of two, I always imagined a third pregnancy would feel like a breeze, even though it had been a decade since I was last pregnant. My first two pregnancies felt easy, with my only “complications” being early contractions with my first, and some sciatic nerve pain with my second.

So when I got pregnant with my third child in 2020, I wasn’t prepared for the heart palpitations, shortness of breath, and fainting I had in my second trimester.

During this pregnancy, I learned something about my body I never knew before: I have a hole in my heart, and it’s gone undiagnosed and undetected my entire life.

When I started having these issues, I wrote them off as typical pregnancy side effects, even though I’d never had them in the past. After all, a slightly elevated heart rate and some shortness of breath is normal during pregnancy because your blood volume increases by 30 to 50 percent. Even fainting can happen in some cases if you’re dehydrated or not eating enough. These symptoms don’t necessarily mean you have heart issues.

But from the beginning, this pregnancy was different. At 15 weeks, I was diagnosed with gestational diabetes. Because I have PCOS, I’d been tested for gestational diabetes fairly early on in each pregnancy, as people with PCOS are typically at higher risk. To help manage my blood sugar levels, I began tracking everything: What I ate and drank, my physical activity, and the results of my blood sugar tests (which I took at least four times per day). I thought maybe in this thorough note-taking, I could get to the bottom of my potentially related heart issues.

Everything seemed in perfect order. Even my blood sugar leveled out with healthy changes, so why was my heart doing all these strange things?

My next move was of course to bring this up to my care team—my primary-care doctor, my midwife, and my OB/GYN. My concerns were dismissed for about two months, though, because I never fainted or got palpitations during an appointment, and my heart rate always seemed fine. It wasn’t until I went to the hospital at 22 weeks for a separate pregnancy issue that things were taken seriously.

While lying down hooked up to monitors in the ER, my heart rate spiked, alarming the nurse writing down my information. “Do you feel that?” She asked, concerned. My response alarmed her further: “Yes, and I’ll pass out in 30 seconds.”

The nurse immediately hit an emergency button above my head and called in three more staff members to try and keep me from passing out. The incident finally prompted my care team to order an ECG (electrocardiogram), and refer me to a cardiologist for a follow-up appointment and series of tests, including blood work, an echocardiogram, and a Holter monitor test, which records your heart’s activity over the course of 24 hours.

A common condition, but a rare diagnosis

The tests revealed a heart murmur (the rushing/whooshing sound of irregular blood flow through the heart), which explained my palpitations and shortness of breath. They also found the small, 1/4-inch hole in my heart that I was likely born with but had not yet caused health problems. This is known as an atrial septal defect, or a hole in the wall of the upper chambers of your heart.

Heart murmurs may sound scary, but they’re actually quite common in people who’re pregnant. In fact, nearly 90 percent of pregnant people develop one. The most common are systolic ejection murmur, which happens when blood flows through a narrowed or irregular valve during heartbeats, and diastolic murmur, which happens while the heart’s relaxed between beats. Most are discovered in the second trimester and disappear within a week after birth without other complications or issues.

My atrial septic defect, on the other hand, was a different story. It’s one of the most common types of congenital heart defects, meaning you’re born with it, but it often resolves once you’re a few months old. It’s rare for it to go undetected until adulthood, and if it doesn’t close, it can cause long-term blood vessel damage in the lungs, high blood pressure, and an increased risk of stroke.

What’s even rarer, though, is for a pre-existing heart issue like atrial septic defect to be discovered during pregnancy.

“Most people that have pre-existing heart issues manage their condition extremely well by working closely with a cardiologist,” says Lauren Brenton, a Sydney, Australia-based midwife with One Mama Midwife. “Though it’s not overly common for women to find heart problems during pregnancy.”

“Heart murmurs may sound scary, but they’re actually quite common in people who’re pregnant. In fact, nearly 90 percent of pregnant people develop one.”

Sometimes the strain put on your heart during pregnancy can bring out a pre-existing condition you didn’t know about, says Brenton. This is why it’s important to bring up any symptoms you’re feeling, so your doctor can investigate further or refer you to a cardiologist for more specialized care.

My situation is rare, but it can happen. Some people may need surgery or medication to treat atrial septic defect and its symptoms, but because mine was small and wasn’t posing immediate threats to my health or my baby, doctors chose to monitor me closely instead. An extra level of care was required because it added a layer of risk to my pregnancy, birth, and postpartum quality of life.

Before leaving the hospital that day, I was inundated with information about my condition, including every risk involved. I also learned a cardiologist would have to be present at my birth in case anything happened.  All I could think about were my older children—how they’d cope with the news of this diagnosis, and how their lives would drastically change if anything happened to me.

As my initial shock melted away during the 45-minute drive home, I went into planning mode. I was determined to do everything possible to make sure this news didn’t negatively affect our lives, and that my pregnancy and birth were healthy.

4 lifestyle changes I made right after my diagnosis

There were four major shifts I made to my life right after my diagnosis, recommended by my care team, in order for my pregnancy and birth to go as smoothly as possible.

I reviewed what I was eating

The first thing I did was take an even closer look at my diet. I had already made changes (like reducing my sugar intake) for my gestational diabetes. The next step was incorporating more heart-healthy foods.

“A good rule of thumb is to eat as close to nature as possible,” says Alison Bailey, MD, a board-certified cardiologist with Parkridge Health System and a physician director for HCA Healthcare. “It doesn’t matter if it’s for heart health, cancer prevention, dementia prevention, or kidney disease. The same diet will help all of those things.”

Fortunately, we lived near a fantastic farmers’ market and the beach, so getting fresh produce like leafy greens, a variety of fruit, and fresh fish was easy. Any other foods rich in healthy fats are good for your heart, too, like nuts and avocado.

“A good rule of thumb is to eat as close to nature as possible.”—Alison Bailey, MD, cardiologist

I reevaluated my exercise routine

Before my diagnosis, I was taking long walks through our closest national park, but because parts of my route were not easily accessible to emergency vehicles, I decided to walk somewhere else.

I started walking along the beach where lifeguards were present if I needed help. I also began taking prenatal yoga classes to improve my strength and flexibility. Even spontaneous forms of movement—like dancing with my kids or playing in the backyard—are good for heart health, so I embraced those opportunities, too.

I tried to reduce my stress

I looked at every possible way to lower my stress during pregnancy and birth. With my first two pregnancies, I didn’t take Lamaze or special breathing classes. I honestly thought breathing techniques and mindfulness were pointless in such intense moments as birth, so I didn’t bother with them.

This time, I did it all. Everything I could do or learn to make my pregnancy and birth easier, I did.

I planned ahead and thought about worst-case scenarios

Lastly, a parent never wants to do this, but my diagnosis forced me to make difficult decisions about my will and think about worst-case scenarios.

Heart disease is the single-largest cause of indirect maternal death, accounting for more than 33 percent of pregnancy-related deaths, according to an April 2021 review in Global Cardiology Science & Practice. Many were never previously diagnosed with heart disease, their diagnosis was delayed because they never sought care, or doctors dismissed their symptoms, per the American Heart Association.

Facing the possibility I could become part of this statistic and planning accordingly was scary, but essential. After I made plans, I had to communicate them to my older kids and extended family.

How my heart condition affected my birth

Because I needed a cardiologist present at my birth, my care team set an induction date, where I would attempt a vaginal birth as I’d done with my first two kids. Coincidentally, I was already in the early stages of labor when we arrived at the hospital, which made things feel easier.

Thanks to breathwork and mindfulness training, along with classes my partner took to learn how to help support me, the birth went perfectly. So perfectly in fact that I didn’t have any heart issues, and during labor my midwife commented, “I may as well not be here, you two have got this!”

My partner and I were able to work together, and he was my greatest advocate, despite not having been part of this process before (he grew up on an island in the South Pacific where men were not involved in birth). He spoke to the midwife with ease and advocated for me so I could focus on my body and labor.

“Having that support person, who knows you and knows how to seek help in those moments, is so important,” says Brenton.

While my birth went incredibly well, beyond anyone’s hopes or expectations, the reality is no two births are the same, and some people may need other interventions. Your doctors may advise you to get an epidural, C-section, or have an early birth to avoid further heart complications. And your recovery may look different and involve regular blood testing, ECGs, and glucose tests if you had gestational diabetes, heart problems, or other birth complications.

Thankfully, a C-section for a heart issue alone is rare, per the Mayo Clinic. But all births and heart defects are different. This is why it’s important to go to all of your appointments before and after you give birth, and let your care team know if notice any unusual symptoms along the way.

Can you give birth again if you have heart issues?

After discovering a heart issue like mine, many may choose not to have more children. But because my older children were so close, and there was a decade between my second and third, I wanted my third child to have a close sibling, too.

The decision to have another child was not taken lightly. My husband and I talked to many medical professionals and prepared as best we could for my fourth pregnancy. Fortunately, my heart was not a problem this time around. I didn’t develop gestational diabetes, and even now, thanks to leading a balanced, healthy lifestyle, I don’t have issues with my heart (no murmur) as my body isn’t pumping the same level of blood it was during pregnancy.

This doesn’t mean my risk of a future health issue is gone, though. Many people who have heart-related health issues during pregnancy can have complications post-birth and later in life, per the National Institutes of Health. Because of this, I have to get an ECG and blood work done regularly. And if anything feels off, my doctor will refer me for a Holter test again.

Depending on your level of risk, your doctor can help you determine whether it’s safe to consider getting pregnant and help you come up with a plan.

The biggest lesson I learned

Advocating for your health is so important, and that often starts with education. If I hadn’t spoken up about my symptoms early on, or gone to the hospital at 20 weeks, I wouldn’t have known what to do to make my pregnancy, birth, and life postpartum easier. Learning about my condition was also crucial for me and my partner, so that we knew when to ask for help and seek care. This also required me to be in tune with my body and recognize when something felt off.

Taking care of my heart in general is another lesson I learned. While I don’t have a heart murmur anymore, I still have a hole in my heart, which can only be fixed with surgery. Thankfully it doesn’t cause issues anymore because I’m not pumping as much blood as I was when pregnant, but I still have to get annual tests to make sure everything is OK, including blood tests, a blood sugar test for diabetes, and an ECG. So far, all results have been ideal, mainly thanks to eating a balanced, heart-healthy diet, exercise, and reducing my stress.

Another important takeaway? Not every symptom in pregnancy will uncover something more serious about your health. But if something feels off, it’s always worth bringing up concerns to your doctor.