Cardiac evaluation in pregnant patients with dyspnea and palpitations

Abstract

BackgroundSymptoms of underlying cardiac disease in pregnancy can often be mistaken for common complaints due to normal physiologic changes in pregnancy. Echocardiographic evaluation of patients with symptoms of palpitations and dyspnea can detect structural changes and identify high-risk features. ObjectiveThe study's objective was to examine transthoracic echocardiograms (TTEs) of perinatal individuals completed for palpitations or dyspnea to determine the frequency of identifying structural changes. Study DesignWe performed a retrospective cohort study of all perinatal individuals with a TTE at a single academic center between October 1, 2017, and May 1, 2022. The indication for the echocardiogram, demographics, and clinical characteristics were recorded. TTEs with any abnormal findings noted in the TTE report were reviewed and categorized into findings of congenital heart disease, valvular disease, pericardial effusion, evidence of ischemia/wall motion abnormalities, abnormal diastolic/systolic function, and other. ResultsOf our sample of 539 TTEs completed on 478 different individuals who were pregnant or in the 12-week post-partum period, 96 (17.8%) had an indication of palpitations and 32 (5.9%) were listed dyspnea as the indication. Abnormal findings were seen in 21.9% of patients with palpitations and in 34.4% of those with dyspnea. In the patients with palpitations who had abnormal findings, 33.3% had congenital heart disease, 33.3% had mild valvular disease including mitral valve prolapse, 19.0% had a pericardial effusion, and 14.3% had evidence of ischemia/wall motion defects. Abnormal TTE findings in the dyspnea cohort included ischemia/wall motion defects (27.3%), mild valvular disease or mitral valve prolapse (36.4%), and abnormal systolic/diastolic function (36.4%). ConclusionMany of the TTEs completed for patients with dyspnea or palpitations identified no structural abnormalities, however, in about one in three to one in four patients underlying structural heart disease was identified. While some of these abnormalities were unlikely to change delivery plans like mild valvular disease or small effusions, others such as ischemia, congenital abnormalities, and abnormal systolic/diastolic function were likely to have implications for pregnancy and post-partum management.