Heart Disease in Pregnancy
Heart disease in pregnancy covers two groups: women who already have a cardiac condition and are planning or expecting a baby, and women whose heart problem first appears during pregnancy or shortly after delivery. Pregnancy is, in effect, a nine month cardiovascular stress test, and it reveals heart conditions as often as it complicates known ones.
Dr Matthew Balerdi provides private pre-pregnancy cardiac assessment and cardiac review during pregnancy in Hull, Grimsby and Scunthorpe, with echocardiography and ECG, both of which are safe in pregnancy. Appointments are typically available within 1-2 weeks.
If you are pregnant and unwell, do not wait for a private appointment
Call 999 for severe breathlessness, chest pain, collapse, coughing up blood, or a fast heartbeat that will not settle. Contact your maternity unit or midwife the same day for reduced fetal movements, severe headache with visual disturbance, sudden swelling of the face or hands, or blood pressure readings of 140/90 mmHg or higher. Private cardiology review works alongside your maternity care, not instead of it.
What Pregnancy Asks of the Heart
The cardiovascular changes of pregnancy are large, predictable, and mostly complete before the third trimester. They are the reason a heart that copes well with ordinary life can struggle in pregnancy, and the reason symptoms often peak earlier than women expect.
Blood volume rises by 40-50%
More volume to move, and more volume for a stiff or leaking valve to handle
Cardiac output rises, heart rate rises
Resting heart rate typically climbs by 10-20 beats per minute, and ectopic beats become more noticeable
Blood pressure falls, then recovers
A mid pregnancy dip is normal, which is why a rising blood pressure in the second half deserves attention
Blood clots more readily
A protective adaptation for delivery, which raises the risk of thrombosis and matters greatly with mechanical valves
Labour and the first days after are the peak
Delivery, and the sudden volume shift immediately afterwards, are when cardiac risk is highest. This is why delivery planning matters
Normal Symptoms Versus Symptoms to Report
Common and usually normal
- Mild breathlessness on exertion or talking
- Awareness of a faster or stronger heartbeat, and occasional missed beats
- Ankle swelling later in pregnancy
- A soft flow murmur, heard in most pregnant women
- Tiredness and reduced exercise tolerance
Report these to your team
- Breathlessness lying flat, or waking you from sleep
- Breathlessness that is progressively worsening
- Chest pain, particularly on exertion
- Blackout, or near blackout on standing
- Sustained fast palpitations, or palpitations with dizziness
- Sudden severe swelling, or rapid unexplained weight gain
- Coughing up blood, or a persistent night cough
Who Should Have a Cardiac Assessment
Ideally before conception. If you are already pregnant, it is never too late to be assessed, and earlier is better than later.
Known heart conditions
- Adult congenital heart disease, repaired or unrepaired, and any Fontan circulation
- Valve disease, especially aortic or mitral stenosis, and any mechanical or tissue prosthetic valve
- Cardiomyopathy of any type, or previous peripartum cardiomyopathy
- Aortic dilatation or an aortopathy such as Marfan, Loeys-Dietz or bicuspid aortic valve with a dilated aorta
- Pulmonary hypertension, which carries the highest maternal risk of any cardiac condition
- Inherited arrhythmia syndromes, an implanted device, or previous ablation
- Previous coronary artery disease, heart attack or spontaneous coronary artery dissection
New findings in pregnancy
- A newly detected murmur that is loud, harsh, diastolic or associated with symptoms
- Breathlessness out of proportion to the stage of pregnancy
- Sustained or symptomatic palpitations, or documented arrhythmia
- Blackout, particularly if it occurs on exertion
- An abnormal ECG found on routine testing
- A strong family history of cardiomyopathy, sudden cardiac death or aortic dissection. See family screening
- Persistent symptoms in the weeks and months after delivery, which are too often attributed to deconditioning
The Main Cardiac Conditions in Pregnancy
Every condition below is individual, and the same diagnosis can mean very different things in two different women. These summaries are a starting point for a conversation, not a substitute for one.
Congenital Heart Disease
The commonest cardiac diagnosis in pregnant women in the UK. Most simple and well repaired lesions tolerate pregnancy well. Complex circulations, a systemic right ventricle, residual cyanosis and Fontan physiology need specialist congenital and obstetric input from the start.
Valve Disease
Regurgitant valves are generally tolerated because pregnancy lowers systemic resistance. Stenotic valves, particularly mitral stenosis and severe aortic stenosis, are the ones that decompensate, because they cannot accommodate the extra volume and faster heart rate.
Mechanical Heart Valves
One of the most difficult situations in cardio-obstetrics. Every anticoagulation strategy trades maternal valve thrombosis risk against fetal risk, and the decision belongs to the woman after a detailed discussion. This is best settled before conception.
Peripartum Cardiomyopathy
Heart failure appearing in the last month of pregnancy or the months after delivery, in a woman with no known heart disease. Symptoms overlap with normal late pregnancy, so diagnosis is often delayed. An echocardiogram settles it quickly, and most women improve with prompt treatment.
Hypertensive Disorders
Chronic hypertension, gestational hypertension and pre-eclampsia. Beyond the pregnancy itself, these are now recognised as markers of long term cardiovascular risk, and warrant blood pressure and risk review in the years afterwards. See high blood pressure.
Arrhythmias
Ectopic beats and sinus tachycardia are extremely common and usually benign. Supraventricular tachycardia often becomes more frequent in pregnancy, and existing arrhythmias tend to behave more actively. Most can be managed medically, with drug choice adjusted for pregnancy.
Aortopathy
Marfan syndrome, Loeys-Dietz, Turner syndrome and bicuspid aortic valve with aortic dilatation all carry a raised risk of aortic dissection in pregnancy and the postpartum period. Aortic dimensions, blood pressure control and delivery planning are central.
Pulmonary Hypertension
The condition with the highest maternal mortality. Pregnancy is generally advised against, and women who become pregnant need immediate referral to a specialist pulmonary hypertension and cardio-obstetric team. Contraception advice is a priority in this group.
Coronary Events and SCAD
Heart attack in pregnancy is rare but rising with maternal age. Spontaneous coronary artery dissection is disproportionately a condition of pregnant and recently pregnant women, and presents as chest pain that should never be dismissed on grounds of age.
Planning a Pregnancy With a Heart Condition
A pre-pregnancy appointment answers three questions: how is the heart now, what does pregnancy add to that, and what needs to be arranged before you conceive.
Establish the baseline
History, examination, ECG and a detailed echocardiogram, with ambulatory rhythm or blood pressure monitoring where relevant. Previous operation notes and imaging are worth bringing.
Estimate the risk
Modified WHO classification places most conditions on a scale from class I, where risk is no higher than the general population, to class IV, where pregnancy is generally advised against. It sets how closely you should be watched.
Review medication
Switch anything unsuitable for pregnancy before conception rather than after a positive test, and confirm what should continue. Nothing is stopped without a replacement plan.
Agree the plan
Who reviews you and how often, which unit you deliver in, what the delivery plan looks like, whether a fetal cardiac scan is needed, and what happens in the postnatal weeks.
Care Through Pregnancy
Women with significant heart disease are looked after jointly, through cardio-obstetric clinics that bring cardiology, obstetrics, obstetric anaesthesia, specialist midwifery and, where relevant, haematology into the same conversation. The pattern of care is broadly:
- Early booking, with cardiology review in the first trimester
- Repeat echocardiography at intervals set by your risk class, commonly around 20 and 30 weeks
- Fetal cardiac scan at around 18-20 weeks where there is congenital heart disease in the family
- A written delivery plan agreed by the third trimester, covering mode of delivery, analgesia, monitoring and who to call
- Postnatal cardiac review, because the first two weeks after delivery carry substantial risk and are frequently the least supervised
A caesarean is not automatically safer with heart disease. For most cardiac conditions a planned vaginal delivery with good analgesia and a shortened second stage is preferred, with caesarean reserved for obstetric reasons or specific cardiac indications.
Cardiac Medicines and Pregnancy
Never stop a heart medicine on your own, and do not rely on a package insert. The decision is always a balance, and uncontrolled heart disease is itself a risk to a pregnancy.
Generally avoided
ACE inhibitors, angiotensin receptor blockers, sacubitril valsartan, statins, spironolactone, amiodarone where alternatives exist
Needs individual planning
Warfarin and other anticoagulants, particularly with a mechanical valve, where the plan often changes by trimester
Commonly continued
Beta blockers such as labetalol and bisoprolol, low dose aspirin where indicated for pre-eclampsia prevention, and several established antiarrhythmics
Breastfeeding compatibility is a separate question from pregnancy safety, and is usually more permissive. Ask specifically about it rather than assuming.
How Dr Matthew Balerdi Can Help
Dr Balerdi is a Consultant Imaging Cardiologist with a specialist interest in heart disease in pregnancy and adult congenital heart disease, leading the Adult Congenital Heart Disease level 3 centre in the Humber Health Partnership and holding an NHS adult congenital appointment with Leeds Teaching Hospitals NHS Trust.
Pre-Pregnancy Assessment
A full baseline cardiac assessment with a clear, individual account of what pregnancy would mean for you, and a medication plan agreed before you conceive.
Assessment During Pregnancy
Rapid access echocardiography and ECG, both entirely safe in pregnancy, for a new murmur, unexplained breathlessness, palpitations or a symptom your team wants clarified.
Postnatal Review
Follow up after peripartum cardiomyopathy, pre-eclampsia or gestational hypertension, and long term cardiovascular risk assessment for women whose pregnancy flagged future risk.
How private cardiac care fits with your maternity care
Private cardiology sits alongside your NHS maternity team, and works best when the two communicate. With your consent, findings and recommendations are shared with your GP, midwife and obstetrician. Where a pregnancy needs joint cardio-obstetric management, high risk obstetric care or delivery in a specialist unit, the role of a private appointment is to identify that early and get you referred to the right team. Obstetric emergencies always go to your maternity unit.
Common Questions
Can I have a baby if I have a heart condition?
Most women with a heart condition can have a successful pregnancy. What changes the answer is which condition you have, how well your heart is working now, and how well the pregnancy is planned. A small number of conditions, including severe pulmonary hypertension, severe unrepaired aortic narrowing, a severely impaired ventricle and significant aortic dilatation in Marfan syndrome, carry high enough risk that pregnancy is usually advised against. That advice is individual and deserves a proper conversation rather than a leaflet.
Why should I be seen before I get pregnant rather than after?
Pre-pregnancy assessment is the single most useful thing you can do. It allows the heart to be imaged in its baseline state, medication to be reviewed and changed safely before conception rather than in a hurry afterwards, risk to be estimated properly, and a plan to be made for who looks after you and where you deliver. Several cardiac medicines are unsuitable in pregnancy and are best swapped before you conceive.
Is breathlessness in pregnancy normal?
Mild breathlessness is very common and usually normal. Blood volume rises by around 40-50%, the heart pumps more with each beat and faster, and the growing uterus pushes up on the diaphragm. What is not normal is breathlessness that wakes you at night, breathlessness lying flat, breathlessness that is getting worse rather than staying steady, or breathlessness with chest pain, coughing up blood, blackout or a persistently fast heart rate. Those need assessment.
Is an echocardiogram safe in pregnancy?
Yes. An echocardiogram uses ultrasound, involves no radiation and no injection, and is safe at every stage of pregnancy and while breastfeeding. ECGs, 24 hour heart monitors and blood pressure monitoring are equally safe. Cardiac MRI can be performed without gadolinium contrast if needed. Tests that involve radiation, such as CT and nuclear scans, are avoided unless the information is genuinely necessary.
What is peripartum cardiomyopathy?
Peripartum cardiomyopathy is heart failure caused by weakening of the heart muscle that appears in the last month of pregnancy or in the months after delivery, in a woman with no previously known heart disease. Symptoms include breathlessness, swelling, fatigue and being unable to lie flat, which overlap with normal late pregnancy, so it is easily missed. Many women recover well with prompt heart failure treatment, and any future pregnancy needs careful specialist discussion.
Can I keep taking my heart medication in pregnancy?
Never stop a heart medication on your own. Some are continued unchanged, some are switched to a safer alternative, and a few must be stopped. ACE inhibitors, angiotensin receptor blockers, sacubitril valsartan, most statins and spironolactone are generally avoided in pregnancy. Warfarin needs individual planning, particularly with a mechanical heart valve, where every anticoagulation option carries trade offs. The right answer is a planned switch, not an abrupt stop.
Will my baby inherit my heart condition?
If you have congenital heart disease, the chance of your baby being affected is higher than the background population risk of roughly 1 in 125, typically in the range of 3-6%, and higher with some specific conditions or an identified genetic syndrome. A detailed fetal cardiac scan at around 18-20 weeks is usually offered, and can be arranged earlier in some units.
Tests You May Need
All of the tests below are safe in pregnancy. None involve radiation, and none require an injection of contrast.
Echocardiogram
Ultrasound of the heart. The key test in pregnancy, safe at every stage, assessing valves, chambers and pumping function
ECG
A five minute recording of the heart's electrical activity, safe throughout pregnancy
24 Hour Monitor
Ambulatory rhythm recording to capture palpitations and distinguish benign ectopics from arrhythmia
Blood Pressure Monitoring
Ambulatory and home monitoring to characterise hypertension accurately in and after pregnancy
Cardiac MRI can be performed in pregnancy without gadolinium contrast when more detail is needed, and is arranged by referral. CT and nuclear cardiac imaging involve radiation and are avoided in pregnancy unless the information cannot be obtained any other way.
Related Conditions
Adult Congenital Heart Disease
The commonest cardiac diagnosis in pregnant women in the UK
Valve Disease and Murmurs
Including prosthetic valves and the murmurs commonly heard in pregnancy
High Blood Pressure
Hypertensive disorders of pregnancy and long term blood pressure risk afterwards
Heart Failure
Including peripartum cardiomyopathy and its treatment and recovery
Initial consultation from £165 · Follow-up from £110 · ECG from £80 · Echocardiogram from £350
View full price list →Reviewed by Dr Matthew Balerdi, Consultant Imaging Cardiologist (FRCP) — Last reviewed: September 2026
Planning a Pregnancy, or Pregnant With Cardiac Symptoms?
The most valuable appointment is the one before you conceive, but assessment at any stage is worthwhile. Echocardiography and ECG are safe in pregnancy and can usually settle the question quickly.