10 minute read
Medically reviewed by Dr Ravi Assomull, Consultant Cardiologist – 21 September 2026
Introduction
Many women experience unexpected changes to their body during pregnancy — breathlessness climbing the stairs, a racing heart at rest, or swollen ankles by the end of the day. Whilst many of these changes are entirely normal physiological responses to pregnancy, they can understandably cause concern, particularly for women who are unsure which symptoms are expected and which may warrant closer attention.
Heart health and pregnancy is an important topic that affects a growing number of women, including those with pre-existing cardiovascular conditions and those who develop cardiac complications during pregnancy for the first time. Cardiovascular disease is one of the leading causes of maternal morbidity in the UK, making awareness and appropriate monitoring especially important.
This article explains how pregnancy affects the heart and circulatory system, which symptoms may benefit from medical evaluation, what cardiology investigations may be relevant, and when speaking with a cardiologist could be appropriate. It is intended as a general educational guide, not a substitute for personalised medical advice.
What Is the Connection Between Heart Health and Pregnancy?
How Pregnancy Changes the Cardiovascular System
Pregnancy places significant additional demands on the heart. From as early as the first trimester, blood volume increases by approximately 40–50%, and the heart must work harder to supply both mother and developing baby with sufficient oxygen and nutrients. Cardiac output — the amount of blood the heart pumps per minute — rises considerably, and the heart rate typically increases by around 10–20 beats per minute above a woman's pre-pregnancy baseline.
These are normal physiological adaptations. However, for women with existing heart conditions, or those who develop cardiovascular complications during pregnancy, these changes can place the heart under considerable additional strain.
The cardiovascular system generally returns towards its pre-pregnancy state within weeks to months after delivery, though some changes — particularly in cases of pregnancy-related heart conditions — may persist and require longer-term monitoring.
How does pregnancy affect heart health?
Pregnancy significantly increases demands on the heart and circulatory system. Blood volume rises by up to 50%, cardiac output increases, and heart rate elevates. Whilst these are normal changes, heart health and pregnancy can interact in complex ways, particularly for women with existing heart conditions or those who develop cardiac complications during pregnancy.
Common Heart Symptoms During Pregnancy
Many cardiovascular symptoms experienced during pregnancy are normal and resolve after delivery. However, some symptoms may indicate an underlying condition requiring further assessment.
Symptoms that may be normal during pregnancy include:
- Mild shortness of breath, particularly in later pregnancy as the uterus expands
- Occasional palpitations or awareness of a rapid heartbeat
- Ankle swelling, particularly towards the end of the day
- Slight dizziness when changing position
Symptoms that should prompt timely medical evaluation include:
- Severe or persistent shortness of breath, particularly at rest or when lying down
- Chest pain or chest tightness
- Persistent palpitations, irregular heartbeat, or a very rapid heart rate
- Fainting or near-fainting episodes
- Sudden, significant swelling of the face, hands, or feet
- Severe headaches or visual disturbances (which may indicate pre-eclampsia)
If you experience severe chest pain, severe breathlessness, or symptoms that feel like a medical emergency, seek urgent medical attention immediately by calling 999 rather than waiting for a routine appointment.
Who Is at Higher Cardiovascular Risk During Pregnancy?
Some women face a higher risk of cardiovascular complications during pregnancy. These include women who:
- Have a pre-existing heart condition, such as a congenital heart defect, valve disorder, or arrhythmia
- Have a history of high blood pressure (hypertension) prior to pregnancy
- Have developed hypertension or pre-eclampsia in a previous pregnancy
- Have a family history of inherited heart conditions
- Have diabetes, which can affect cardiovascular health
- Are of older maternal age, as cardiovascular risk increases with age
- Have experienced peripartum cardiomyopathy in a previous pregnancy
Women in these categories are often advised to undergo pre-conception counselling and specialist joint cardiac and obstetric care throughout pregnancy. Early specialist input can play an important role in pregnancy planning and monitoring.
Cardiovascular Conditions That May Arise During Pregnancy
Peripartum Cardiomyopathy
Peripartum cardiomyopathy is a rare but serious condition in which the heart muscle weakens during the final month of pregnancy or within the first five months after delivery. It leads to reduced heart function and can cause symptoms such as breathlessness, fatigue, swollen legs, and palpitations. With appropriate medical management, many women experience significant or complete recovery of heart function, though outcomes vary between individuals.
Pregnancy-Related Hypertension and Pre-Eclampsia
High blood pressure during pregnancy can take several forms, including gestational hypertension and pre-eclampsia. Pre-eclampsia involves high blood pressure alongside other signs, such as protein in the urine, and can affect multiple organ systems including the heart. Women who experience pre-eclampsia may have a modestly elevated long-term cardiovascular risk and may benefit from appropriate follow-up after pregnancy.
Arrhythmias During Pregnancy
Palpitations and certain arrhythmias can occur or become more frequent during pregnancy due to hormonal changes and increased cardiac workload. Whilst many palpitations during pregnancy are benign, some arrhythmias may require further evaluation and, in some cases, treatment. A private cardiology consultation can help assess whether palpitations require further investigation.
Cardiology Tests That May Be Relevant During or After Pregnancy
Depending on a woman's symptoms, clinical history, and circumstances, a cardiologist may recommend one or more of the following investigations:
Echocardiogram
An echocardiogram uses ultrasound to produce detailed images of the heart's structure and function. It is a safe, non-invasive test commonly used to assess heart muscle function, valve function, and cardiac output. It is often recommended for women with known heart conditions before or during pregnancy, and for those suspected of conditions such as peripartum cardiomyopathy.
ECG (Electrocardiogram)
An ECG records the electrical activity of the heart and can help assess heart rhythm and identify certain arrhythmias. It is a quick, non-invasive test that does not involve radiation and is safe to perform during pregnancy.
Ambulatory ECG Monitoring (Holter Monitoring)
For women experiencing intermittent palpitations or suspected arrhythmias, a Holter monitor records heart rhythm over 24–48 hours or longer, allowing the cardiology team to review rhythm during everyday activities and during any symptomatic episodes.
Blood Pressure Monitoring
24-hour ambulatory blood pressure monitoring provides a comprehensive picture of blood pressure patterns over a full day and night, which can be particularly useful for assessing hypertension in pregnancy or evaluating blood pressure control.
Test and investigation suitability always depends on individual clinical circumstances and will be determined by the responsible clinician.
Prevention and Supporting Heart Health During Pregnancy
Whilst not all cardiovascular complications during pregnancy can be prevented, there are steps women can take to support their heart health:
- Attend all antenatal appointments: Regular monitoring of blood pressure, urine, and general health allows early identification of any concerns.
- Maintain a balanced diet: A varied diet rich in fruit, vegetables, wholegrains, and lean protein supports overall cardiovascular health.
- Stay appropriately active: Gentle physical activity, such as walking or pregnancy-specific exercise, can support cardiovascular health — but always follow guidance from your midwife or doctor.
- Avoid smoking: Smoking significantly increases cardiovascular risk and should be avoided during pregnancy.
- Moderate alcohol intake: Alcohol should be avoided during pregnancy due to its potential effects on both mother and baby.
- Manage stress where possible: Chronic stress can affect blood pressure and overall wellbeing.
- Seek pre-conception advice if you have a known heart condition: Planning ahead with your cardiology and obstetric teams can make a significant difference.
These measures are not a guarantee of preventing cardiovascular complications, as individual risk varies depending on personal health history and other factors.
When to Seek Cardiology Assessment
Speak with your GP, midwife, or a cardiologist if:
- You have a known heart condition and are planning pregnancy
- You have experienced cardiovascular symptoms during pregnancy that have not been fully explained
- You have been told you have a heart murmur
- You have a family history of inherited heart conditions
- You experienced hypertension, pre-eclampsia, or peripartum cardiomyopathy in a previous pregnancy
- You are experiencing persistent palpitations, breathlessness, or chest discomfort
- You are concerned about your cardiovascular health following pregnancy
For symptoms that feel severe or sudden — including chest pain, significant breathlessness, or collapse — seek emergency medical attention immediately.
Key Points to Remember
- Pregnancy significantly increases demands on the heart and circulatory system, with blood volume rising by up to 50%.
- Many cardiovascular symptoms during pregnancy are normal, but some warrant timely medical evaluation.
- Women with pre-existing heart conditions require specialist monitoring and ideally pre-conception counselling.
- Peripartum cardiomyopathy and pregnancy-related hypertension are serious conditions that require prompt medical assessment.
- Cardiology tests such as echocardiograms, ECGs, and ambulatory monitoring can help evaluate cardiovascular health safely during or after pregnancy.
- If you experience severe or sudden symptoms, seek urgent medical attention rather than waiting for a routine appointment.
Frequently Asked Questions
Is it safe to have cardiology tests during pregnancy?
Most standard cardiology investigations, including ECGs and echocardiograms, are safe during pregnancy as they do not use ionising radiation. Your clinical team will always consider safety and clinical necessity before recommending any investigation. Some tests involving radiation may be avoided unless clinically essential. Individual suitability is always assessed by the responsible clinician based on your personal circumstances and stage of pregnancy.
Can pre-existing heart conditions affect pregnancy outcomes?
Women with pre-existing heart conditions can often have successful pregnancies, but specialist input is important. The type and severity of the condition, how well it is controlled, and individual circumstances all play a role. Pre-conception counselling from a cardiologist and an obstetrician experienced in high-risk pregnancies helps ensure appropriate planning, monitoring, and support throughout pregnancy and the postnatal period.
What is peripartum cardiomyopathy and how is it treated?
Peripartum cardiomyopathy is a rare condition in which the heart muscle weakens during late pregnancy or shortly after delivery, reducing the heart's pumping efficiency. Treatment typically involves medications to support heart function and reduce workload, with close monitoring by a cardiologist. Many women experience significant recovery of heart function over time, though outcomes vary, and long-term follow-up is often recommended.
Can pregnancy increase long-term cardiovascular risk?
Some pregnancy complications, such as pre-eclampsia and gestational diabetes, are associated with a modestly increased long-term cardiovascular risk. This does not mean cardiovascular disease is inevitable, but it highlights the importance of appropriate follow-up, a heart-healthy lifestyle, and awareness of cardiovascular risk factors in later life. Women who have experienced these complications are encouraged to discuss their long-term cardiovascular health with their GP.
What should I do if I notice palpitations during pregnancy?
Occasional palpitations during pregnancy are common and often benign, related to the increased demands on the heart. However, persistent, frequent, or distressing palpitations — particularly those accompanied by dizziness, fainting, or chest discomfort — should be reported to your midwife or GP. They may refer you for further assessment, which could include an ECG or ambulatory heart rhythm monitoring to identify any underlying cause.
When should I see a cardiologist rather than just my GP or midwife?
A cardiology referral may be appropriate if you have a known heart condition, experience symptoms that have not been fully explained, have a relevant family history, or if initial investigations suggest a cardiac cause for your symptoms. Your GP or midwife can make a referral when they feel specialist assessment is clinically appropriate. Some women prefer to seek a private cardiology consultation, particularly if they wish to discuss their cardiovascular health in more detail or access specialist advice promptly.
Conclusion
Heart health and pregnancy is a topic that deserves careful attention. The physiological changes of pregnancy are remarkable, but for some women, they can place additional demands on a heart that may already face challenges. Understanding which symptoms are a normal part of pregnancy and which may warrant further evaluation is an important step in supporting both maternal and foetal wellbeing.
Whether you are planning a pregnancy with a known heart condition, have noticed cardiovascular symptoms during pregnancy, or are concerned about your heart health after delivery, seeking appropriate professional advice is always the right course of action.
Cardiovascular symptoms, test results, and treatment options should always be assessed individually based on a person's clinical history, symptoms, and appropriate medical examination.
Disclaimer: This article is intended for general educational purposes only and does not constitute personalised medical advice, diagnosis, or treatment. Cardiovascular symptoms and conditions can vary between individuals. If you have concerns about your heart health or symptoms, seek appropriate advice from a qualified healthcare professional. If you experience symptoms that may indicate a medical emergency, seek urgent medical attention.
Next Review Due: 21 September 2027
