By Karin Fleming and Liz Madison, Vitals contributors
It’s no surprise to hear that pregnant people can experience shortness of breath, swollen feet and fatigue. But for some of those who are expecting, these and other clinical symptoms can be signs of misdiagnosed or undetected cardiovascular disease.
“The first presentation of cardiovascular disease may be during pregnancy or early postpartum, with the highest risk period for worsening disease at 24-28 weeks gestation or postpartum,” says Beth Stephens-Hennessy, a perinatal clinical nurse specialist at Sutter Medical Center, Sacramento.
Stephens-Hennessy says these stark realities are not meant to scare. They are meant to create awareness for patients. They are also helping spark change with healthcare providers.
Stephens-Hennessy and other multidisciplinary experts created a standardized assessment to improve detection and diagnosis of cardiovascular disease in pregnant and perinatal patients. It is used with all pregnant and postpartum patients during triage assessment, upon admission and in patients who develop symptoms during hospitalization.
Initially piloted at Sutter Medical Center, Sacramento, the assessment recently was implemented across Sutter’s entire integrated network in Northern California.
Various health experts are more closely examining these mimicking symptom scenarios for pregnant people. Cardiovascular disease is the leading cause of pregnancy-related maternal deaths, according to the California Department of Public Health. The data also estimates that 83% of those cases could have been preventable.
The new screening tool, modeled on one developed by the California Maternal Quality Care Collaborative, has shown to have big impacts elsewhere. Data from academic medical centers in California and New York using a perinatal screening tool show that upward of 10% of patients screened positive for cardiovascular disease from April 2018 to July 2019. As experts note, this can have immediate and long-term positive impacts on one’s health.
“We adopted this approach to address an unmet, critical clinical need,” said Suzanne Bressler, who focuses on clinical performance improvement for Sutter Health. “The screening algorithm highlights patients at higher lifetime risk of cardiovascular disease and may identify a group that could be targeted for more direct care transitions postpartum.”
These symptoms can be shared by both pregnant people and those with cardiovascular disease. Evaluation of these symptoms play a major role in Sutter’s perinatal cardiovascular screenings.
• Decreased tolerance to exercise
• Hyperventilation/shortness of breath
• Discomfort when breathing while lying down flat
• Light headedness
• Dizziness/temporary loss of consciousness caused by falling blood pressure
• Labored breathing
• Gravity-related swelling in the lower body
• Jugular vein distention
• Murmurs/alterations in heart sounds
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