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Heart Palpitations During Pregnancy Symptoms, Causes And Treatment

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Heart palpitations are described as the sensation of abnormal heartbeats. Heart palpitations during pregnancy may be felt during rest or physical activity and are generally not a cause for alarm. However, it is essential to report any occurrences of heart palpitations during pregnancy to your Ob/Gyn to rule out any other problems.

Read this post to learn more about the symptoms, causes, signs, complications, diagnosis, treatment, and home care tips for heart palpitations during pregnancy.

Symptoms Of Heart Palpitations During Pregnancy

Pregnant women may experience the following sensations in the throat, neck, or chest during palpitations (1):

  • Racing or pounding heartbeat
  • Fast heartbeats
  • Skipping beats
  • Sudden fluttering
  • Flip-flopping

The kind of heartbeat sensation, duration, and intensity may vary in each woman. For example, palpitations can last for a few seconds to several minutes or hours, depending on the underlying cause.

Causes Of Heart Palpitations During Pregnancy

Heart palpitations are normal in most pregnant women. However, if it occurs with other symptoms, such as chest pain and breathing problems, it can be due to underlying medical conditions requiring immediate medical care.

The common harmless causes of heart palpitations during pregnancy include (2) (3) (4) (5):

  • Hormone changes
  • Upward shift of the diaphragm due to the growing uterus
  • Increased blood volume
  • Dietary factors, such as increased caffeine intake from tea, coffee, energy drinks, cola, or diet pills
  • Certain medications, such as decongestants (pseudoephedrine or phenylephrine), asthma inhalers, and tablets for hypothyroidism
  • Heavy exercises
  • Stress, fear, panic attack, and anxiety
  • Obesity and overweight

The following medical conditions can cause palpitations due to irregular, stronger, or faster heartbeat during pregnancy:

  • Preeclampsia
  • Arrhythmias (abnormal heart rhythms), such as atrial fibrillation and supraventricular tachycardia (SVT)
  • Thyroid problems, such as an overactive thyroid
  • Pulmonary hypertension
  • Coronary artery diseases and other heart diseases
  • Heart valve problems, such a mitral valve prolapse
  • Low blood sugar levels (hypoglycemia)
  • Abnormal potassium levels in the blood
  • Low oxygen levels in the blood
  • Low blood pressure (hypotension)
  • Infection and fever
  • Dehydration
  • Diabetes
  • Anemia (low red blood cell count)

Although palpitations can be due to many harmless causes during pregnancy, experts warrant medical attention to exclude the diagnosis of serious conditions.

Complications Of Heart Palpitations During Pregnancy

Complications are less likely to develop if no underlying heart conditions are causing the palpitations. However, the following complications may appear if heart problems cause palpitations (1): 

  • Fainting may occur when the heart beats faster than normal (tachycardia) due to low blood pressure (hypotension). It is more common in pregnant women with heart valve problems and congenital heart diseases.
  • Cardiac arrest is the loss of heart function caused by sudden irregular heartbeats (arrhythmias)—a life-threatening medical emergency.
  • Heart failure occurs when the cardiac muscles do not pump as much blood as usual. It can also occur due to prolonged arrhythmias such as atrial fibrillation.
  • Stroke may occur if palpitations are due to arrhythmias, such as atrial fibrillation that affect the heart’s upper chambers (atria). Blood may collect and form clots during arrhythmia, blocking a brain artery and resulting in a shock.

Appropriate management of heart conditions during pregnancy can help reduce the risk of these fatal complications.

Signs You Need To See A Doctor

Heart palpitations during pregnancy that occur frequently or last for long periods may need medical evaluation. Seek emergency medical care if the heart palpitations feel different than before or you experience any of the following symptoms along with the palpitations (5) (6):

  • Chest pain
  • Fainting
  • Dizziness or lightheadedness
  • Shortness of breath
  • Profuse sweating
  • Feeling extra heartbeats, such as more than six beats per minute
  • Having cardiac risk factors, such as diabetes, high blood pressure, and high cholesterol
  • Pulse rate is more than 100 beats per minute without fever, anxiety, or physical activity

Seeking medical care on time can prevent complications.

Home Care For Heart Palpitations During Pregnancy

Identifying and avoiding triggers for palpitations can help reduce their incidence. Preventive home care is only recommended for non-severe palpitations. The following home care measures may help reduce heart palpitations in some expecting mothers (5) (7):

  • Get enough rest
  • Stay hydrated
  • Avoid caffeine
  • Avoid the use of alcohol, cigarettes, and other tobacco products
  • Avoid physical exertion
  • Take cold water baths
  • Practice deep breathing, yoga, tai chi, meditation, and other relaxation techniques
  • Refrain from recreational drugs and illegal drug use
  • Always seek prescription medications during pregnancy

If you have palpitations due to stress and anxiety, discuss various methods to reduce them with your doctor. Also, remember that palpitations due to underlying medical conditions do not resolve with home care measures but may require medical treatment.

Diagnosis Of Heart Palpitations

Although not harmful in many cases, it is best to evaluate heart palpitations to know the underlying cause. The diagnosis of palpitations may include the following steps (8):

  • Doctors may ask questions to exclude dietary factors, physical exertion, or panic attacks causing palpitations.
  • Detailed medical history to know if the expecting mother has any existing heart problems.
  • An electrocardiogram (ECG) is often ordered to analyze the electrical activity of the heart. It may help diagnose arrhythmias and other rhythm abnormalities of the heart
  • Blood tests to check for anemia, abnormal hormone levels, and other factors causing palpitations.
  • Doctors may suggest wearing a heart monitor (Holter monitor) for a few days to notice irregular heartbeats if the other tests could not determine the cause.
  • Coronary angiography is only done if there is an indication of underlying heart conditions.

Doctors may order a few more tests based on the underlying cause identified during the initial evaluation.

Treatment For Heart Palpitations

Heart palpitations without underlying heart conditions are harmless and may resolve without any treatment. Doctors may recommend avoiding certain foods or medications causing palpitations. Further, treating underlying heart conditions and other medical issues causing palpitations can improve the condition over time.

Heart palpitations due to stress and anxiety are challenging to manage since they trigger further panic or anxiety in some women. Doctors may prescribe anxiolytic medications to break these cycles of anxiety and palpitations in severe cases (8).

Other Effects Of Pregnancy On The Heart

Hormonal changes and the growing uterus can affect heart functions during pregnancy, causing temporary discomfort in some expectant mothers. The following changes that occur in pregnancy can affect the heart (9):

  • Increase in blood volume: Almost a 50% increase in blood volume occurs during pregnancy due to endocrinological (hormonal) factors such as hormones from the placenta or placental circulation acting as a shunt. Increased plasma volume (fluid volume in the blood) may play an important role in placental circulation.
  • Increase in cardiac output: The heart works harder than normal in pregnancy to meet the blood supply needs of the growing fetus in the uterus, which receives one-fifth of the blood supply by the end of the A 30–50% increase in cardiac output (amount of blood pumped by the heart) during pregnancy is normal. When the cardiac output increases, the heart rate (number of heartbeats per minute) also increases from 70 to 90 beats per minute.

Cardiac output can be higher during physical activity in pregnant women than in nonpregnant women. Usually, the cardiac output decreases rapidly after delivery and returns to a pre-pregnancy level at around six weeks postpartum. 

  • Heart rhythm abnormalities and abnormal heart sounds: Hormonal changes and the heart’s increased workload can result in rhythm irregularities during Increased blood flow can also cause abnormal heart sounds such as murmurs due to turbulence. However, abnormal heart rhythms and heart sounds, such as diastolic or systolic murmurs, require medical care.
  • Blood pressure changes: During pregnancy, low blood pressure (hypotension) is seen in the second trimester that returns to normal in the third trimester. However, blood pressure can be high in some women due to pregnancy-induced hypertension or preeclampsia. Reduced systemic vascular resistance can also cause blood pressure changes during pregnancy.
  • Reduced venous return: An enlarged uterus may exert pressure on larger veins and affect the normal return of blood from the pelvic area and legs to the heart, resulting in edema (swelling) of the legs and varicose veins in the legs and the vaginal opening (vulva).

Some women may experience itching, pain, and discomfort due to varicose veins. Wearing special stockings and elastic support hose, lying on the left side, and keeping legs elevated can ease discomfort.

These are normal physiological changes during pregnancy that are resolved by delivery. Pregnancy-related hemodynamic changes contribute to optimal development and growth of the baby and protect the mother from delivery risks, such as hemorrhage (bleeding).

Heart palpitation is usually normal in pregnancy and caused by bodily changes. However, it is recommended to seek medical care for frequent and prolonged palpitations to identify the cause. In addition, palpitations with other cardiac symptoms may require immediate medical care.

References:

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Dr Bisny T. Joseph

Dr. Bisny T. Joseph is a Georgian Board-certified physician. She has completed her professional graduate degree as a medical doctor from Tbilisi State Medical University, Georgia. She has 3+ years of experience in various sectors of medical affairs as a physician, medical reviewer, medical writer, health coach, and Q&A expert. Her interest in digital medical education and patient education made... more