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Question:

Can LV enlargement be caused by breastfeeding? 

Hi, I am a 30 year old female who has recently been experiencing fatigue and mild heart palpitations. My father was diagnosed with a dilated cardiomyopathy at age 49 and was implanted with a pacemaker defibrillator. I have been clean for 5 and a half years, but was a daily heavy methamphetamine addict for over 2 years. I am now in college, married, and have two beautiful little girls both under the age of 5. I have become concerned about the possible repercussions of my past, and have recently opted to undergo extensive medical testing. I went to a cardiologist and told him about my substance abuse history as well as my father. He ordered an echocardiogram, and the results came back that I had a slightly dilated left ventricle but normal functioning. The cardiologist said he was not particularly concerned, but that I could come back in 3 months for another echo. I am currently breastfeeding, and he said he thinks the enlargement could be due to the breastfeeding. My question is, has anyone else ever heard of LV enlargement due to breastfeeding? I have googled high and low and cannot find ANY information regarding such an occurrence. Also, shouldn't I/he be more concerned about the enlargement, even if it is "mild"? I have read that cardiomyopathies can advance very quickly. Is it possible that even though the echo shows normal function, I could have a cardiomyopathy either from my past drug abuse or my genetics? I am very concerned and wonder if I should seek a second opinion, or push my doctor to do further testing? He did originally offered to do a nuclear stress test, but since I am breastfeeding, this is not an option. Thank you in advance for any information you can give me. Additional information: I am a normal healthy weight, normal blood pressure, I do not smoke, but I do have a consistently high resting heart rate.  

submitted by Anita from Oklahoma on 12/17/2011

Answer:

by Texas Heart Institute cardiologist, Scott R. Sherron, MD  

Scott R. Sherron, MDAnita, I have a particular interest in cardiac disease related to pregnancy and therefore feel comfortable in addressing this issue. You are correct that cardiac enlargement is not a normal feature of breastfeeding. Although there is a mild increase in metabolic rate, the overall increase in blood flow and cardiac output are much less than during pregnancy. I have more concern that your report of an elevated resting heart rate, especially coupled with a history of exposure to substances that are adrenergic stimulants, could lead to a tachycardia-induced cardiomyopathy. This is not, however, a type of cardiomyopathy that is likely to progress rapidly as might a viral or peripartum cardiomyopathy.  A followup echo in 3 months to assess function is quite reasonable.  I would consider a 24 hour holter to assess average heart rate and, if elevated, consider a beta-blocker. Some are safe in breastfeeding -- always confirm with your pediatrician.  Another non-toxic way to assess LV and RV function would be a cardiac MRI which is even safe during pregnancy and would offer a second modality for measurements of cardiac size and function. I hope this is helpful.  

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Updated December 2011
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