Do not be enough for the heart. Memo for pregnant women from cardiologist

All who gave birth or dealt with pregnant women know what an alarming period and how any suspicion of doctors can plunge a pregnant woman in panic. Cardiologist, Olga Movchan, shared with us a very useful text about when a pregnant woman does not need to worry and listen to those who scares her.

Still, Abram Lvovich Syrkin was right. I remember in 1993 on the student circle he asked: "Do you think that the most difficult for a doctor?" Arriving an audience of an insightful look and, as probably expected, without waiting for any replica, after a significant pause, he answered himself: "The most difficult for a doctor is not treated." It was about those situations when, without a doctor's intervention, it is possible and, moreover, it is desirable to do.

Today I woke me a phone call. Called familiar acquaintances in tears and despair. She is offered to interrupt a long-awaited pregnancy for a period of 16 weeks due to the discovered supraventic extrasistoly. The doctor told her that she would not make pregnancy, but "even if Cesarean would not understand whether it would be removed from the table."

It no longer surprises me and is not even angry. The story is familiar. It will not be an exaggeration to say that every week, women come to me, who are forbidden to pregnant or offer to interrupt pregnancy due to extrasystole. Frankly, I even embarrass about it to write (sorry, colleagues): In any guidance on making pregnant women with cardiac pathology, and just in any leadership in arrhythmology it is written that extrasystolia is not a dramatically severe disease. This is a common place. But the fact remains a fact. Doctors are very often and easily offered to interrupt pregnancy when the extrasystole is detected without any reason.

The attitude of doctors to interrupt pregnancy is a separate and ambiguous topic. While I decided to write a popular article, about pregnancy and extrasystole. Maybe what pregnant will read.

Rhythm disorders are found in pregnancy quite often. This is due to the fact that during pregnancy, by virtue of hormonal and hemodynamic changes, there are prerequisites for the occurrence or exacerbation of existing rhythm disorders. Despite the fact that dangerous rhythm violations are quite rare, the very fact of their detection often scares patients and doctors.

In front of me young beautiful woman. Face expressions sorrowful, in the eyes of tears. "Doctor, please save me and my child." The first time when I started working with pregnant women, having heard a similar, I shuddered, and felt a light chill in the field of solar plexus.

"I was told that it was necessary to interfere with the pregnancy, but I don't want."

At this point, I was preparing to hear a dramatic diagnosis and scrolls in my heads of psychological support to a woman, because, of course, there are medical testimony to interrupt pregnancy. It is always difficult and very sad.

- What happened to you?

Thin fingers are thrown in the folder, go through the documents. Finally I take the results of the survey. Of course, we all withdraw, if necessary, but what do colleagues write? Watching: "Echocardiography is in order. ECG - without deviations from the norm. The results of daily monitoring of the Holter: 2652 ventricular EXRACSISTOL, including 12 bakers and (circled red) 2 jogging, each of the 3 complexes from the heart rate 182 wt. in min. "

In view of a woman. Everything is fine. - Does anything worries you? - Not. Nothing. The therapist heard that the pulse was uneven, sent to a survey. And there it is! - Is that all?

I exhaled with relief. Indications for the interruption of pregnancy by cardiology is not. Save, most likely, no one will have to. Hooray! Woman 10 minutes cries, habitual for new information, now from joy. Yes, she will have to be observed at the Cardiologist during this pregnancy, but there is nothing tragic in it.

Over the past two years, out of pregnant women who applied to the rhythm violations for consultation in our department, the testimony for the interruption of pregnancy was only in the 2nd. Both cases were associated with high pulmonary hypertension against the background of non-operated DMPP (congenital heart disease).

The remaining cases that frightening doctors not only did not require interruption of pregnancy, but often did not require special treatment at all, although there were grounds for the cardiac observation of pregnant women. Despite repeatedly published articles and clinical guidelines for the treatment of rhythm disorders, which say that dangerous arrhythmias during pregnancy are rarely found quite rarely, a woman who is either not allowed to be pregnant on every purpose, or recommended to interrupt pregnancy due to rhythm violations in Cases when there were no contraindications for pregnancy.

Rhythm disorders occurs during pregnancy quite often. According to different researchers from 7 to 52% of pregnancies proceeds with some arrhythmias. In the recommendations of the European Association of Cardiologists, it is said that 20-44% of pregnant women detect various rhythm and conductivity disorders. Although in pregnancy, any violations of the rhythm may occur, most often they are not life-in-making, do not require interrupts of pregnancy and quite often do not even need some kind of specific treatment. Nevertheless, of course, there are situations in which treatment is necessary.

We decided to publish a possible algorithm of actions and wishes to pregnant women who diagnose violations of heart rhythm.

The reason to appeal to the cardiologist and additional examination may be:

- Arrhythmia is diagnosed on an ECG planned during pregnancy; - the doctor discovered a neurotic heartbeat during inspection; - you are concerned about something from the following: - the attacks of the rapid heartbeat; - the feeling of interruptions in the work of the heart; - heart failure; - shortness of breath; - pre-sensor or trimming States; - swelling; - increase blood pressure; - You have been diagnosed with rhythm disturbances before pregnancy.

If the doctor has revealed a rhythm disturbance, do not be afraid. Remember that during pregnancy, the rhythm disturbance is quite common. They, as a rule, are not a reason for interrupting pregnancy, in most cases do not affect pregnancy, although they require circulation to a cardiologist, surveys and, in some cases, treatment.

As an additional examination, the doctor most likely will suggest you:

- Echocardiography of the ECG monitoring of blood collector analyzes, general, is a biochemical blood test (necessarily with the study of blood electrolytes) - blood test to the hormones of the thyroid gland, if necessary, blood test for the antibodies to myocardium

Be sure to pass surveys to determine the causes of arrhythmia. This will allow the doctor to decide whether you need therapy at this stage or can be limited to observation.

In case treatment is necessary, do not worry. When choosing drug treatment, the doctor will first be guided by security for the fetus and for you. The treatment is shown if:

- Revealed arrhythmia can threaten your health and life or affect the development of the baby; - the rhythm violation is accompanied by impaired hemodynamics (including the fall of blood pressure, dizziness, fainted states, edema of the lungs); - arrhythmia is poorly transferred by you, accompanied by pronounced discomfort, anxiety, Anxiety.

Even if the doctor decided that treatment is necessary, and the prescribed medicines are not effective enough or ineffective, do not despair. This happens extremely rarely. But in this case there are no absolute indications for the interruption of pregnancy. The intervention of interventional surgeons can help get rid of rhythm violations in such a situation. With the help of special equipment, under X-ray control, bringing an electrode through the vessels in the heart cavity, in many cases the surgeon can eliminate the arrogan hearth - the cause of arrhythmia. It is better to carry out such a procedure for a period of 26-28 weeks, since the fetus at this moment is almost formed.

There are situations where rhythm disorders require emergency medical intervention. If you feel that against the background of the rhythm violations, you have pronounced weakness, dizziness, blood pressure is greatly reduced, a pre-corrupt state occurs, it is necessary to immediately cause ambulance.

If you have diagnosed rhythm disorders and you are only planning a pregnancy, it is better to surveide the cardiologist and evaluate the risks of aggravation of rhythm disorders during pregnancy. Perhaps you have a rhythm disorders do not need treatment and risks will be minimal. Then wonderful. Pregnant and enjoy. But when arrhythmia requires serious treatment, and it can be eliminated, it will be better to get rid of unwanted symptoms "on the shore." In some types of arrhythmias, it is possible to eliminate arrhythmogenic hearth with the help of interventional surgery. And then being a pregnant, you will go over again to walk in the park, listen to music, or meet with friends, in general, make what you love, instead of dragging at the reception to the cardiologist.

And finally, if the rhythm violation is diagnosed, there are a number of recommendations that can improve your condition before you hit the cardiologist. You can: - eliminate coffee from a diet, strong tea and other exciting drinks - not to drink chocolate- exclude alcohol- stop smoking- to set up the day of the day - to sleep at least 8 hours- Include into your schedule daily walks - try to distan from situations that Can provoke psycho-emotional stress. Although it is often even more difficult than abandoning chocolate, try to avoid everything that can bring you out of yourself. Pregnancy - no time to learn to express emotions. That is, if you can, excellent. But, if not, just stay away from annoying situations.

Sometimes these simple changes in lifestyle can significantly improve well-being. And this is enough, or needed an additional examination and treatment, you will help to understand a qualified doctor.

In any case, if you are offered to interrupt pregnancy due to cardiac pathology, before making a decision, get a second opinion from a specialist.