Cardiovascular changes during uncomplicated pregnancy

  Blood volume increases 40-45%

  Cardiac output increases 30%

  Heart rate increases 10-20%



ECG changes during uncomplicated pregnancy

  Frequent atrial premature contractions (APC).

  Frequent ventricular premature contractions (VPC).

  These frequent premature contractions usually decrease in frequency after pregnancy.



Pregnancy and Long QT Syndrome

  Life-threatening cardiac events increase in the postpartum period in patients with congenital long QT syndrome (especially in LQTS type 2).



Peripartum cardiomyopathy

  There are no specific ECG findings for peripartum cardiomyopathy.

  Sinus tachycardia, atrial fibrillation, atrial flutter, ventricular tachycardia, bundle branch block, T wave inversion or signs of left ventricular hypertrophy may be seen.

  New development of Left Bundle Branch Block (LBBB) should raise the suspicion for developing peripartum cardiomyopathy.

  QRS widening (>120 msec) has been identified as a predictor for mortality in this patient group.



References

  Curr Opin Cardiol 2014;29:36-44.

  Methodist Debakey Cardiovasc J 2013;9:38-43.

  Int J Cardiol 2003;88:129-133.

  Eur Heart J 2011;32:1076.

  Arch Mal Coeur Vaiss 2004;97:25-30.

  Circulation 1998;97:451-456. 

  Circulation 2005;111:e161.

  Comprehensive Electrocardiology. Peter W. Macfarlane. 2nd ed. Springer-Verlag London 2011.