What should I do about palpitations during my pregnancy?

I am a 29 year old female and have experienced heart palpitations for years with the frequency varying. I have never been overweight and am usually very fit. Last year I noticed that they were very frequent (multiple times a day, well over 100) at the start of my menstrual cycle and on the day before and the day of ovulation. I noticed this pattern for about 10 months and then they just never went away when ovulation was over. They have been constant for well over a year now. By constant I mean multiple times a minute. I am now pregnant (I got pregnant 10 months AFTER the palpitation became a daily occurrence). My cardiologist had an EKG and an echo done and observed the palpitations during both tests. The structure and blood flow were all normal on the echo. He said they were PACs and the rhythm was normal sinus rhythm. He has not ordered any blood work and since I do not have insurance he says to only come in if there is a problem. He described the heart as resetting itself constantly. However, I am now worried that during labor when there are hormonal changes they could get really bad. They have been constant during this pregnancy but have gotten a little less since the first trimester has been over (I am 30 weeks along, due beginning of July). I have had two natural out-of-hospital labor and deliveries and am planning to do that again. For a little personal medical history, I have a very minor thalassemia trait (Delta Beta) and am always anemic, with iron being fine. My hemoglobin (usually about 10) and hematocrit, MVC, MCH, MCHC are always low, platelets are always low as well, usually 120. I have absolutely no caffeine intake and haven’t in over a decade. I don’t have refined sugar and I eat very healthy, plenty of good fats and clean food. So with the connection with hormonal changes what test should be ordered? I believe that they do not happen when I am asleep but I have not had a monitor so it is just a feeling I have. Thank you so much for any advice you can give me.

Submitted by Regina from Virginia on 04/29/2014

by Deborah E. Meyers, MD

Dear Regina,
Your situation is complicated to say the least. Let me recap. You have a baseline history of palpitations and tachycardia which you have had for many years. You are healthy and fit. You have anemia due to a thallasemia trait. The frequency of your symptoms appear (over the years) to be related to your menses.

You saw a cardiologist and he found that you had no structural heart disease ( normal echo) and said that your symptoms were due to PAC’s. No further work up was done. You have no insurance. You are now pregnant and you are worried about the impact of these palpitations on your pregnancy and upcoming labor. You plan on giving birth in an out of hospital setting.
You have symptoms that bother you and that is your body telling you something. I think you need to listen. You have had an evaluation by a cardiologist but you do not seem to be fully reassured by this encounter. It is unclear if your cardiologist wanted further assessments or not – you seem to infer that things were not done because of your lack of insurance ie monitoring at night. Let me say this clearly: Persistent tachycardia is not such a good thing. First, it bothers you. Second, it may or may not have an ill effect on your heart if it continues unchecked over the intermediate or long term future. I would not let this slide if I were you. I would suggest that you look into some Medicaid that may be offered in your state ( if you qualify) and is usually available to pregnant uninsured mothers. I checked the website and the state of Virginia does have such a program. This would likely cover the costs of a cardiology consult and even a specialist electrophysiology consult, if needed. You should discuss this with your obstetrician if you have one. If you don’t, I would encourage you to get one, and discuss your symptoms with him or her. They will be in a good position to assess the impact of the tachycardia on your pregnancy and they will also be able to give you some feedback on the hormonal aspect of your situation. I suspect there are some (probably not all) obstetricians that would respect your choice to have a natural out of hospital labor or back up a midwife if they are reassured that it is a safe option for you. Please remember: The goal of the pregnancy of course is for you and your baby to come through it safely. Pregnancy like motherhood and life can require flexibility. I would encourage you to pursue this further as it is clearly concerning you.