One evening during the 34th week of my first pregnancy, I was at home after a fantastic and relaxing day. Work was going well, my pregnancy was going well, I had just taken a hot shower and was resting on the couch with my dog and a smoothie. I felt calm, happy, and relaxed… when suddenly my heart started pounding fast.
I was no stranger to a pounding heart from anxiety, but I wasn’t anxious at all! I checked my FitBit watch and saw my heart rate was at 160. That seemed impossible, but my heart was racing hard enough I believed it. I closed my eyes for a minute to see if I could relax myself and slow my heart rate, to no avail. After calling my OB, I was sent directly to the Emergency Department where I received an EKG that showed atrial fibrillation! I barely knew what that was, and yet here I was: 29 years old, 34 weeks pregnant, and diagnosed with atrial fibrillation.
What is Atrial Fibrillation?
According to Mayo Clinic, Atrial Fibrillation, or Afib, is “an irregular and often very rapid heart rhythm. An irregular heart rhythm is called an arrhythmia. During atrial fibrillation, the heart’s upper chambers—called the atria—beat chaotically and irregularly. They beat out of sync with the lower heart chambers, called the ventricles.”
Not everyone feels the irregular beating immediately—but I did. Afib can cause symptoms like heart palpitations, a high heart rate that may jump around (my own went from 80 to 220 and everything in between), fatigue, shortness of breath, dizziness, and weakness. Some people may not feel any symptoms at all, or they may experience short bursts of symptoms that may last for a few minutes. Afib can go away on its own without medical intervention, but it can last for hours to days or even longer.
Afib and My Pregnancy
When left untreated, afib can cause blood clots, which can cause a stroke. This is dangerous for everyone, but becomes more complicated with a pregnant person. Treatment options are also limited while pregnant because some of the medications are not safe for pregnant people. I was lucky that mine started in my third trimester, when some medications that wouldn’t have been safe earlier were now fine for me to take.
My baby’s heart rate stayed normal for the entire time I had afib, but when my heart rhythm flipped into normal rhythm, my heart rate suddenly dropped from 160 to 40 BPM which made my baby’s heart rate drop to 40 BPM. I was on heart monitors for both myself and my baby for the whole time I was in the hospital, and when the nurse saw my baby’s heart rate drop with mine we had a very short window of time for her heart rate to rebound before they would have needed to do an emergency c-section. I thankfully avoided needing an emergency c-section, but I had about 30 seconds to spare before I would have been wheeled into the operating room.
My resting heart rate had been climbing steadily higher during my pregnancy, but at my routine visit just days before my episode my OB assured me that was normal. I already had psoriatic arthritis among other chronic illnesses, so I had been pretty uncomfortable for my entire pregnancy so far and was attempting to take how I felt in stride. My body was working harder, after all, and I was entering the most uncomfortable stage of pregnancy for most everyone.
While many pregnant people have a slightly higher resting heart rate, my cardiologists at the hospital said the stress on my heart from the pregnancy, along with a long family history of atrial fibrillation, flipped my heart rhythm from normal to afib. I hadn’t even known atrial fib ran in my family until my mom arrived at the hospital and answered that question for the doctors and me! At my routine visit, my OB thought my increasing heart rate was normal because to some extent, it is normal in pregnancy. I hadn’t told her about my family history of afib because I didn’t know about it at the time, and even so, I was young with little risk factors.
Treating My Afib
I ended up staying in the hospital for four days, because it took three days and several medications for my heart rate to flip into normal rhythm. My official diagnosis was Paroxysmal atrial fibrillation, which means my afib lasted less than seven days, and I was instructed to follow up with a cardiologist after I was released from the hospital.
I was started on a beta blocker, which causes the heart to beat slower and with less force. My doctors explained beta blockers are safe for pregnancy, and the only potential side effect on my baby would be a lower birth weight. My baby was measuring normal, but I did have to get a few extra scans to confirm she continued to grow as expected. It was important for me to take the beta blocker to prevent another episode so I could avoid another hospital stay and the potential emergency c-section, which had scared me badly.
I had always been prone to tachycardia, or a high heart rate, and the beta blocker helped keep my heart rate at a normal rate and rhythm. I also had to wear a heart holter monitor for several days, which is a small, battery powered heart monitor that was glued to my chest to track my heart rate and rhythm. It had a button on the device I could press whenever I felt symptoms and I filled out a log with information about the symptoms so the data could be reviewed alongside my log. I’ve done as short as two days and as long as two weeks with a holter monitor, and it provided my cardiologist with valuable information about my heart rate and rhythm to improve my symptoms and help identify my triggers.
AFib can be caused by heart or thyroid problems, sleep apnea, and other health conditions. My cardiologist even told me some people develop AFib after a viral infection, like pneumonia, or when one’s electrolytes are out of balance like with the stomach flu. It can also be caused by external factors like stimulant drugs, tobacco, alcohol, or caffeine. Because my bloodwork was normal, I wasn’t sick, and I wasn’t using any substances to cause it while I was pregnant, it was determined my afib was caused by my pregnancy and related to my family history. Afib is most common in people 65 and older, so I was unusual to be both pregnant and 29 years old. My OB told me later I was the only person to ever be diagnosed with afib at their large OB/GYN practice!
Labor and Beyond
My pregnancy progressed with definitely more anxiety than I had before, but overall normally for the final weeks. I was induced and placed on a heart monitor in case my afib came back during the stress of labor, but the beta blocker kept my heart rate and rhythm normal.
I identified stress, heat, fatigue, not eating enough, and dehydration as my major triggers for heart palpitations and tachycardia, and those together can cause afib for me. In the years since, I have done my best to keep my lifestyle managed as well as possible to avoid flaring my heart. As I had several chronic illnesses before I had afib, a careful lifestyle to manage my conditions and triggers was very much a part of my life anyway.
I ended up having afib for a second time when I was 33 after an extremely stressful week during the summer when I wasn’t eating enough from the stress. This episode lasted only 45 minutes, and my heart flipped back into normal rhythm while sitting in the waiting room at the Emergency Department. Afterwards, my cardiologist had me start seeing an electrophysiologist, a different kind of cardiologist who specializes in heart rhythms, and I switched from my beta blocker to an antiarrhythmic that controls my heart rhythm better.
Like many chronic illnesses, my afib is something I have to be aware of every day but it also does not rule my days. As long as I take my medications and manage my triggers, I am able to do most everything I want to do. I wear an Apple Watch so I can track trends in my heart rate and use the ECG function if I’m concerned about my heart rhythm. I’m even able to send the ECG to my cardiologists, so I can get advice from them without having to go straight to the hospital.
While untreated afib can potentially cause a blood clot and lead to a stroke, afib is able to be treated and managed with medications and lifestyle management. While atrial fib is still rare in pregnancy, it can become a very serious situation if left untreated. Always contact your doctors with any concerns or unusual symptoms like a pounding, racing heart rate.
