When to Refer to Cardiology: Murmur Classifier & Echo Criteria Guide

Quick take: In pregnancy, most heart murmurs are harmless, but certain characteristics—like a harsh, systolic murmur, new‑onset symptoms, or abnormal echo findings—warrant prompt cardiology referral. An echocardiogram is indicated when the murmur is persistent, associated with red‑flag signs, or when you have risk factors such as pre‑existing heart disease, hypertension, or a family history of cardiomyopathy. Follow the step‑by‑step referral pathway outlined below to keep both mom and baby safe.

It’s 2 a.m., you’ve just felt a flutter in your chest after climbing the stairs to the nursery, and the internet is buzzing with “Is a heart murmur during pregnancy normal?” questions. You’re not alone—many expectant parents wonder whether that new sound means trouble, or if it’s simply the heart working a little harder.

We’ve gathered the latest guidance from the American College of Obstetricians and Gynecologists (ACOG), the UK’s National Institute for Health and Care Excellence (NICE), and cardiology societies to give you a clear, practical roadmap. You’ll learn how clinicians classify murmurs in pregnancy, which red‑flag signs trigger a cardiology consult, when an echocardiogram is truly needed, and how the obstetric and cardiology teams coordinate care. We’ll also explore how to interpret echo results in plain language, what lifestyle adjustments can ease symptoms, and why postpartum follow-up is critical—even if the murmur seems to disappear after delivery.

By the end of this article you’ll be able to recognize the warning signs, understand the echo criteria, and feel confident in the referral process—so you can focus on the excitement of meeting your baby, not the uncertainty of a murmur.

Understanding heart murmurs in pregnancy

During pregnancy the circulatory system expands dramatically: blood volume rises by up to 50 % and cardiac output climbs 30‑50 %. This physiological surge can cause turbulent flow that produces a soft, “innocent” murmur. Most clinicians describe these as:

• Timing: systolic (between the first heart sound and the second), often crescendo‑decrescendo.
• Quality: musical, low‑grade (grade I‑II), and heard best at the left lower sternal border.
• Change with position: louder when the patient sits up, softer when supine.

In contrast, a pathological murmur signals underlying structural disease—valve stenosis, regurgitation, or cardiomyopathy. These murmurs tend to be:

• Harsh, high‑grade (III‑VI), or continuous.
• Associated with abnormal heart sounds (e.g., clicks, gallops) or a palpable thrill.
• Unchanged or louder when the patient lies down, because increased venous return accentuates turbulence.

Obstetric providers routinely listen for murmurs at each prenatal visit. If a murmur is heard, they assess its characteristics, compare it to any prior exams, and consider the patient’s history. The Paediatric Murmur Classifier offers a useful framework for quantifying murmur intensity, although pregnancy‑specific tools are still emerging. Some centers now use handheld ultrasound devices during prenatal visits to quickly assess valve function, which can help distinguish innocent from pathological murmurs without waiting for a formal echocardiogram.

It’s worth noting that the prevalence of an audible murmur rises after the first trimester, when plasma volume peaks. In most cases the murmur disappears within weeks after delivery, reflecting the reversal of the hemodynamic load. However, a small proportion of women discover that a murmur heard in pregnancy uncovers a previously silent congenital valve lesion—highlighting why careful classification matters. For example, a bicuspid aortic valve (the most common congenital heart defect) may only become detectable when cardiac output increases, making pregnancy a critical window for diagnosis.

Red‑flag signs that prompt cardiology referral

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1. New‑onset murmur after the first trimester without a prior cardiac history.
2. Harsh, high‑grade murmur (III or higher) especially if it radiates to the neck or back.
3. Associated symptoms: unexplained dyspnea at rest, orthopnea, chest pain, palpitations, syncope, or presyncope.
4. Signs of heart failure: peripheral edema beyond the ankles, rapid weight gain (>1 kg/week after 20 weeks), or a new S3 gallop.
5. Abnormal vital signs: systolic blood pressure > 140 mmHg, heart rate > 110 bpm, or oxygen saturation < 94 %.
6. Pre‑existing cardiac disease: known congenital valve lesions, hypertrophic cardiomyopathy, or previous rheumatic fever.
7. Risk factors for cardiomyopathy: family history of dilated cardiomyopathy, prior chemotherapy, or uncontrolled hypertension.

If any of these are present, the obstetric team should arrange a cardiology consult within 48 hours. Early involvement helps prevent decompensation, guides medication adjustments, and informs delivery planning. For instance, a woman with a new harsh murmur and chest pain may need immediate evaluation to rule out aortic dissection—a rare but life-threatening condition that requires urgent intervention.

Red‑flag signs are not a checklist to self‑diagnose; they are cues for your provider to act. For example, a mild increase in swelling that mirrors normal pregnancy changes is usually benign, but sudden, disproportionate swelling—especially if it appears in the face or hands—should be reported promptly. Similarly, palpitations that occur only with exertion are often harmless, but those that wake you from sleep or are accompanied by dizziness warrant further evaluation.

When to order an echocardiogram for a pregnant woman

An echocardiogram (echo) is a non‑invasive ultrasound that visualizes heart structure and function. Current guidelines recommend an echo when:

• The murmur is Grade III or louder, or has a harsh quality.
• There are red‑flag symptoms (see above) or abnormal physical findings.
• The patient has a known cardiac diagnosis that requires monitoring (e.g., repaired tetralogy of Fallot, bicuspid aortic valve).
• There is suspicion of peripartum cardiomyopathy—especially after 20 weeks gestation with new heart failure signs.
• Maternal hypertension is uncontrolled and the provider needs to assess left ventricular function.

Below is a concise table summarizing echo indications and the specific criteria that trigger imaging.

Echo is safe throughout pregnancy because it uses sound waves, not ionizing radiation. The American Society of Echocardiography (ASE) advises that the procedure be performed by a sonographer trained in obstetric imaging to minimize fetal exposure to the transducer pressure. Some centers use a "fetal-friendly" protocol, which limits the duration of imaging over the uterus and avoids unnecessary views that could increase pressure on the fetus.

In practice, most obstetric units schedule the echo on the same day a red‑flag murmur is identified. The results usually return within 24 hours, allowing the cardiology team to make rapid, evidence‑based recommendations. If the echo is abnormal, the cardiologist may recommend additional imaging, such as a cardiac MRI (avoiding gadolinium contrast in the first trimester) to further evaluate complex congenital lesions or myocardial disease.

Step‑by‑step referral pathway during prenatal care

Having a clear workflow reduces delays and ensures that every pregnant patient with a concerning murmur receives timely specialist input. The following algorithm reflects best practice at major academic centers and aligns with ACOG’s “Cardiac Disease in Pregnancy” recommendations:

1. Initial detection: During the routine auscultation at 12‑week anatomy scan, the provider notes a murmur and records its grade, timing, and quality. If the murmur is new or changed from a prior exam, the provider documents the location where it’s loudest (e.g., aortic area, pulmonic area) and whether it radiates to other areas like the neck or back.
2. Risk assessment: The provider reviews the patient’s cardiac history, hypertension status, family history, and any accompanying symptoms. They also check for risk factors like prior chemotherapy (e.g., anthracyclines), autoimmune diseases (e.g., lupus), or a history of preeclampsia, which can increase the risk of peripartum cardiomyopathy.
3. Red‑flag screening: If any red‑flag signs are present, the provider initiates a same‑day cardiology referral and orders a stat echocardiogram. In some cases, they may also order a 12-lead ECG to check for arrhythmias or signs of ischemia, though this is not routinely needed for all murmurs.
4. Low‑risk scenario: For an innocent‑sounding murmur without red flags, the provider schedules a repeat auscultation at the 28‑week visit and advises the patient to report any new symptoms. They may also provide a handout on warning signs to watch for, such as sudden shortness of breath or chest pain.
5. Echo results review: The cardiology team interprets the echo, classifies the murmur (innocent vs. pathological), and recommends management—ranging from observation to medication adjustment or, rarely, surgical intervention. If the echo shows mild valve disease, the cardiologist may recommend a repeat echo in the third trimester to monitor for progression.
6. Joint care plan: Obstetrician, maternal‑fetal medicine (MFM) specialist, and cardiologist co‑author a care plan that includes activity recommendations, medication safety (e.g., beta‑blocker use per FDA pregnancy categories), and delivery timing (often aiming for a vaginal birth if cardiac status is stable). The plan also outlines contingency measures, such as the need for invasive monitoring during labor or the availability of cardiac surgery backup if delivery occurs at a tertiary center.
7. Follow‑up: The patient is seen every 4‑6 weeks in a combined obstetric‑cardiology clinic until delivery, then reassessed postpartum (6‑12 weeks) for resolution of any murmurs that were pregnancy‑related. If the murmur persists postpartum, the cardiologist may recommend long-term follow-up to monitor for late complications, such as valve deterioration or arrhythmias.

This pathway keeps communication transparent, reduces unnecessary testing, and ensures that any emerging cardiac issue is caught early. Many centers now use shared electronic health records (EHRs) to streamline communication between obstetricians and cardiologists, reducing the risk of missed referrals or delayed care.

Interpreting common echocardiographic findings in pregnant patients

When the echo report arrives, several key parameters guide decision‑making. Below we translate the technical language into plain English you might hear from your cardiologist.

• Ejection fraction (EF): This number tells how well the heart pumps blood. An EF ≥ 55 % is normal; 45‑54 % is mildly reduced and may warrant closer monitoring, especially if you have symptoms. In pregnancy, EF can dip slightly due to the increased blood volume, but a drop below 45% is concerning and may indicate peripartum cardiomyopathy or other pathology.
• Valve gradients: For aortic or pulmonary stenosis, the echo measures the pressure difference across the valve. A gradient < 30 mmHg is usually mild, while > 50 mmHg may need medication or, in rare cases, intervention before delivery. For example, severe aortic stenosis (gradient > 60 mmHg) can increase the risk of heart failure during labor and may require balloon valvuloplasty or valve replacement before delivery.
• Regurgitation severity: Leaky valves are graded from mild to severe. Mild regurgitation often poses no risk, but severe mitral regurgitation can lead to pulmonary edema and may influence delivery timing. The echo report may describe regurgitation as "trace," "mild," "moderate," or "severe," with severe cases often requiring closer monitoring or medication to reduce afterload.
• Left atrial size: Enlargement suggests chronic pressure overload. A left atrial diameter > 3.8 cm may indicate diastolic dysfunction, which can make the heart less efficient at filling with blood. In pregnancy, left atrial enlargement can also occur due to the increased blood volume, but persistent enlargement postpartum may signal underlying valve disease or hypertension.
• Right ventricular (RV) function: The RV handles blood flow to the lungs. Reduced RV function can be a sign of pulmonary hypertension, which is high‑risk in pregnancy. The echo may measure RV size, wall motion, and tricuspid regurgitation velocity to assess RV function and estimate pulmonary artery pressure.
• Global longitudinal strain (GLS): This newer measure assesses how well the heart muscle fibers are contracting. A GLS value less negative than -18% (e.g., -16%) may indicate early systolic dysfunction, even if the EF is normal. GLS is particularly useful in pregnancy because it can detect subtle changes in heart function before symptoms appear.

Most echoes in pregnancy show normal EF and only mild valve changes, confirming that the murmur is innocent. If the echo reveals any of the above abnormalities, the cardiology team will discuss treatment options—ranging from medication adjustments (e.g., low‑dose beta‑blockers) to closer surveillance in a specialized obstetric‑cardiology unit. For example, if the echo shows moderate mitral regurgitation, the cardiologist may recommend avoiding strenuous activity and monitoring for symptoms of heart failure, such as shortness of breath or fatigue.

It’s also common to see a mild increase in cardiac chamber size simply due to the expanded blood volume. These “physiologic” changes are distinguished from pathology by looking at wall thickness, flow patterns, and the presence of symptoms. For instance, a slightly enlarged left ventricle with normal wall thickness and no symptoms is likely a normal adaptation to pregnancy, while a thickened left ventricle with reduced EF may indicate hypertrophic cardiomyopathy or hypertensive heart disease.

How to prepare for your cardiology appointment

If your obstetrician refers you to a cardiologist, a little preparation can help you make the most of the visit. Here’s what to expect and how to get ready:

• Gather your records: Bring a list of all medications (including over-the-counter supplements), your prenatal records, and any prior cardiac tests (e.g., ECGs, echoes, or stress tests). If you’ve had a murmur in the past, note when it was first detected and whether it’s changed during pregnancy.
• Write down your symptoms: Keep a diary of any episodes of shortness of breath, chest pain, palpitations, or dizziness. Note what you were doing when the symptoms occurred (e.g., climbing stairs, lying down) and how long they lasted. This can help the cardiologist determine whether the symptoms are related to the murmur or another cause, such as anemia or anxiety.
• Prepare questions: Jot down any concerns you have about the murmur, such as whether it will affect your delivery plan, whether you can continue exercising, or whether you’ll need medication. Common questions include:
  • Is my murmur likely to worsen as pregnancy progresses?
  • Will I need a repeat echocardiogram later in pregnancy?
  • Are there any activities I should avoid?
  • How will this affect my birth plan (e.g., vaginal vs. cesarean delivery, pain management options)?
  • Will I need cardiac monitoring during labor?
• Bring a support person: If possible, bring your partner or a family member to the appointment. They can help you remember the details of the discussion and provide emotional support. Some women find it helpful to record the conversation (with the cardiologist’s permission) so they can review it later.
• Dress comfortably: Wear a loose-fitting top that allows easy access to your chest for the physical exam and echocardiogram. You may also be asked to remove jewelry or other metal objects for the echo.

The cardiologist will likely start by reviewing your medical history and symptoms, then perform a physical exam, including listening to your heart with a stethoscope. They may also order additional tests, such as a 12-lead ECG or a repeat echocardiogram, depending on their findings. After the appointment, they’ll send a summary of their recommendations to your obstetrician, who will incorporate them into your overall care plan.

Management options and follow‑up after cardiology assessment

Management depends on the echo findings and the patient’s symptom profile. Here are the typical pathways:

1. Innocent murmur, normal echo: No treatment needed. Continue routine prenatal visits. Educate the patient on warning signs (e.g., new shortness of breath, chest pain) and advise to report them immediately. The cardiologist may recommend a repeat auscultation at the 36-week visit to confirm the murmur hasn’t changed, but no further testing is usually needed.
2. Mild valve disease, stable EF: Observation with repeat echo each trimester. Activity may be limited to low‑impact exercise; heavy lifting is discouraged. For example, a woman with mild mitral regurgitation may be advised to avoid activities that cause breathlessness or fatigue, such as running or high-intensity interval training. The cardiologist may also recommend avoiding excessive salt intake to reduce fluid retention.
3. Moderate‑to‑severe valve disease or reduced EF: Consider medication (beta‑blocker, ACE‑inhibitor if after the first trimester and indicated). A multidisciplinary team may schedule delivery at a tertiary center with cardiac surgery backup. In extreme cases, percutaneous valve repair may be performed in the second trimester. For example, a woman with severe aortic stenosis may require balloon valvuloplasty to reduce the pressure gradient across the valve and lower the risk of heart failure during labor.
4. Peripartum cardiomyopathy suspicion: Immediate hospitalization, diuretics, and guideline‑directed heart‑failure therapy. Delivery planning involves balancing maternal stability with fetal maturity—often a planned early‑term cesarean if the mother’s condition deteriorates. Women with peripartum cardiomyopathy may also require anticoagulation to reduce the risk of blood clots, especially if their EF is severely reduced.

Post‑delivery, most pregnancy‑related murmurs either disappear or become harmless. However, a follow‑up echo 6 weeks postpartum is recommended to confirm resolution, especially if the echo was abnormal during pregnancy. Women who required medication during pregnancy are usually transitioned to postpartum‑compatible drugs under close supervision. For example, if you were taking labetalol for hypertension, your cardiologist may switch you to a different beta-blocker, such as metoprolol, which is also safe for breastfeeding.

Breastfeeding considerations are also discussed, with many beta‑blockers (e.g., labetalol) deemed compatible with lactation by the FDA. However, some medications, such as ACE inhibitors, may need to be avoided if you’re breastfeeding, as they can pass into breast milk and affect the baby’s kidneys. Your cardiologist will work with your obstetrician to find a safe and effective medication regimen that supports your heart health while minimizing risks to your baby.

What to expect during labor and delivery with a heart murmur

If you have a heart murmur, your delivery plan will be tailored to your cardiac status. Here’s what you can expect:

• Delivery location: Women with significant valve disease or reduced EF may deliver at a tertiary care center with a cardiac ICU and neonatal intensive care unit (NICU) on-site. This ensures that both you and your baby have access to specialized care if complications arise. For example, if you have severe aortic stenosis, your delivery team may include a cardiologist, an obstetric anesthesiologist, and a cardiac surgeon on standby.
• Mode of delivery: Vaginal delivery is preferred for most women with heart murmurs, as it carries a lower risk of bleeding, infection, and thromboembolism compared to cesarean delivery. However, a cesarean may be recommended if you have severe aortic stenosis, pulmonary hypertension, or other high-risk conditions. Your cardiologist and obstetrician will discuss the pros and cons of each option and make a recommendation based on your specific situation.
• Pain management: Epidural anesthesia is generally safe and can help reduce the stress of labor on your heart by lowering your blood pressure and heart rate. However, if you have certain conditions, such as severe aortic stenosis, your anesthesiologist may need to adjust the epidural dose to avoid a sudden drop in blood pressure. In some cases, a combined spinal-epidural (CSE) technique may be used to provide rapid pain relief while minimizing hemodynamic changes.
• Cardiac monitoring: During labor, your heart rate, blood pressure, and oxygen saturation will be continuously monitored. If you have a significant murmur or reduced EF, you may also have an arterial line placed to provide real-time blood pressure monitoring. In some cases, a pulmonary artery catheter may be used to monitor your heart’s filling pressures and guide fluid management.
• Second stage of labor: Pushing during the second stage of labor can increase your heart’s workload, so your obstetrician may recommend assisted delivery with forceps or vacuum extraction to shorten this phase. This is especially important if you have severe valve disease or reduced EF, as prolonged pushing can lead to cardiac decompensation.
• Postpartum monitoring: After delivery, you’ll be closely monitored for signs of heart failure or arrhythmias, as the postpartum period is a high-risk time for cardiac complications. You may need to stay in the hospital for a few extra days for observation, especially if you have a significant murmur or reduced EF. Your cardiologist may also recommend a repeat echocardiogram before discharge to assess your heart’s function after delivery.

Your delivery team will work together to create a personalized birth plan that prioritizes your safety and your baby’s well-being. Be sure to discuss any concerns or questions you have about labor and delivery with your obstetrician and cardiologist well in advance, so you feel prepared and supported.

Coordinating care across obstetrics, maternal‑fetal medicine, and cardiology

Effective communication is the cornerstone of safe maternal cardiac care. Here are practical steps to keep the team aligned:

• Shared electronic health record (EHR) notes: Ensure that cardiology summaries, echo images, and obstetric plans are uploaded to a common folder accessible to all providers. This allows each team member to review the latest test results, medication changes, and care recommendations in real time, reducing the risk of miscommunication or missed updates.
• Joint clinic appointments: Many centers schedule combined obstetric‑cardiology visits every 4 weeks for high‑risk patients. This reduces duplicate appointments and allows real‑time discussion. For example, if your echo shows mild mitral regurgitation, your cardiologist and obstetrician can discuss whether you need a repeat echo in the third trimester or whether your current management plan is sufficient.
• Delivery planning conference: At 32‑34 weeks, the obstetrician, MFM specialist, cardiologist, and anesthesiologist meet (in person or virtually) to finalize the birth plan, discuss anesthesia options, and arrange neonatal support. This meeting ensures that everyone is on the same page and that contingency plans are in place for potential complications, such as preterm labor or maternal decompensation.
• Patient‑centered education: Provide a written summary of the diagnosis, medication list, and warning signs. Use plain‑language handouts from the AHA or NHS to reinforce verbal counseling. For example, you might receive a handout on "Heart Murmurs in Pregnancy: What to Expect" that explains the difference between innocent and pathological murmurs, lists red-flag symptoms, and outlines your follow-up plan.
• Telehealth check-ins: For women who live far from a tertiary care center, telehealth visits can bridge the gap between in-person appointments. Your cardiologist can review your symptoms, adjust medications, and answer questions via video call, reducing the need for long travel times. Some centers also use remote monitoring devices, such as blood pressure cuffs or pulse oximeters, to track your cardiac status between visits.

When each discipline respects the others’ expertise, the mother experiences a seamless care journey, and the baby benefits from a well‑coordinated delivery plan. For example, if your cardiologist recommends a cesarean delivery due to severe aortic stenosis, your obstetrician can work with the anesthesiologist to ensure that your pain management plan is optimized for your cardiac condition, while the MFM specialist can coordinate with the NICU team to prepare for your baby’s arrival.

Lifestyle considerations for pregnant women with heart murmurs

Beyond medical monitoring, everyday habits can influence how a murmur feels and whether symptoms develop. The American College of Cardiology (ACC) advises pregnant patients with cardiac concerns to adopt a heart‑healthy lifestyle that balances fetal nutrition with maternal cardiovascular load.

• Physical activity: Light‑to‑moderate aerobic exercise (e.g., walking, swimming, prenatal yoga) is generally safe and may improve cardiac efficiency. Aim for 30 minutes of moderate activity most days of the week, but listen to your body—if you feel short of breath, dizzy, or fatigued, slow down or stop. Avoid high‑intensity interval training, heavy lifting, or activities that cause sustained Valsalva maneuvers (e.g., weightlifting, intense core exercises), as these can increase your heart’s workload and worsen symptoms.
• Nutrition: A diet rich in omega‑3 fatty acids (found in fatty fish, flaxseeds, and walnuts), whole grains, and leafy greens supports vascular health. Limit excess sodium (aim for < 2,300 mg/day) to reduce fluid retention and edema. Stay hydrated, but avoid excessive fluid intake, as this can increase your blood volume and strain your heart. If you have a specific valve condition, such as mitral stenosis, your cardiologist may recommend a low-sodium diet to reduce the risk of pulmonary edema.
• Stress management: Chronic stress raises heart rate and blood pressure. Techniques such as prenatal yoga, guided breathing, or short mindfulness sessions can keep the autonomic nervous system balanced. Consider apps like Headspace or Calm, which offer pregnancy-specific meditation programs. If you’re feeling overwhelmed, don’t hesitate to reach out to a mental health professional—many therapists specialize in perinatal mental health and can provide coping strategies tailored to your needs.
• Sleep posture: As the uterus enlarges, lying flat on the back can compress the inferior vena cava, increasing cardiac preload and murmur intensity. Side‑lying, especially on the left, improves circulation and often reduces murmur audibility. Use pillows to support your belly and back, and consider a pregnancy wedge pillow to keep you comfortably on your side throughout the night.
• Travel considerations: If you’re planning to travel, discuss your plans with your cardiologist. Long flights or car rides can increase the risk of blood clots, especially if you have a mechanical heart valve or a history of thromboembolism. Your cardiologist may recommend compression stockings, frequent movement, or anticoagulation during travel. If you’re traveling to a high-altitude destination, be aware that the lower oxygen levels can increase your heart’s workload—your cardiologist may advise against such trips if you have significant valve disease or reduced EF.

These lifestyle tweaks are not a substitute for medical care, but they empower you to feel more in control of your heart health while you await test results or specialist appointments. For example, if you’re waiting for an echocardiogram, practicing stress-reduction techniques can help ease your anxiety, while staying hydrated and avoiding excessive salt can minimize fluid retention and edema.

Medication safety and heart health during pregnancy

When a pathological murmur is identified, medication may become part of the treatment plan. The FDA categorizes drugs for pregnancy safety; most beta‑blockers (e.g., labetalol, metoprolol) fall into Category C but have extensive data supporting safe use after the first trimester. ACE inhibitors and ARBs, however, are contraindicated because they can cause fetal renal dysplasia.

• Beta‑blockers: Often first‑line for hypertension or tachyarrhythmias. They reduce heart rate and myocardial oxygen demand, which can alleviate murmur‑related symptoms. Monitoring of fetal growth is recommended because some studies suggest a modest reduction in birth weight. For example, labetalol is commonly used to treat pregnancy-related hypertension and is generally considered safe, but your obstetrician may order growth ultrasounds to ensure your baby is developing normally.
• Anticoagulation: Women with mechanical heart valves may require low‑molecular‑weight heparin (LMWH) throughout pregnancy, as warfarin is teratogenic. Dosing is weight‑adjusted and monitored with anti‑Xa levels. For example, if you have a mechanical mitral valve, your cardiologist may switch you from warfarin to LMWH as soon as you confirm your pregnancy, then monitor your anti-Xa levels weekly to ensure you’re receiving the correct dose.
• Diuretics: Used sparingly for pulmonary congestion. Loop diuretics (e.g., furosemide) are considered safe, but clinicians balance fluid removal against the risk of reducing placental perfusion. For example, if you develop pulmonary edema due to severe mitral regurgitation, your cardiologist may prescribe a short course of furosemide to reduce fluid overload, but they’ll monitor your kidney function and electrolyte levels closely to avoid complications.
• Antiarrhythmics: If you develop an arrhythmia, such as atrial fibrillation, your cardiologist may prescribe a medication like digoxin or sotalol to control your heart rate. These drugs are generally considered safe in pregnancy, but they require close monitoring to ensure they’re effective and not causing side effects, such as bradycardia or QT prolongation.

All medication decisions are individualized. Your cardiology team will discuss risks, benefits, and any necessary fetal monitoring before starting or adjusting therapy. For example, if you have severe aortic stenosis and develop heart failure symptoms, your cardiologist may recommend starting a beta-blocker to reduce your heart’s workload, but they’ll also order a fetal echocardiogram to check for any signs of distress. They’ll also discuss the risks and benefits of breastfeeding while taking the medication, as some drugs can pass into breast milk and affect your baby.

Postpartum follow‑up and long‑term cardiac monitoring

The first weeks after delivery are a vulnerable period for cardiac decompensation, especially in women who had a borderline murmur or mild ventricular dysfunction during pregnancy. The ESC and ACOG both recommend a dedicated cardiac review within 6 weeks postpartum.

• Echo reassessment: A repeat echocardiogram confirms whether any structural changes have resolved. Persistence of a murmur after delivery may indicate a pre‑existing valve lesion that warrants ongoing cardiology care. For example, if your echo during pregnancy showed mild mitral regurgitation, your postpartum echo will help determine whether the regurgitation has improved, stayed the same, or worsened. If it’s improved, you may not need further follow-up, but if it’s worsened, your cardiologist may recommend long-term monitoring or medication.
• Blood pressure surveillance: Post‑partum hypertension can emerge even in women without prior hypertension. Home blood pressure monitoring is encouraged, with a threshold of > 140/90 mmHg prompting a provider visit. If you had gestational hypertension or preeclampsia, your risk of developing chronic hypertension is higher, so your cardiologist may recommend regular blood pressure checks for several months after delivery.
• Contraception counseling: Certain cardiac medications interact with hormonal contraceptives. Non‑estrogenic methods (e.g., progestin‑only pills, IUDs) are often preferred for women with significant valve disease. For example, if you’re taking a beta-blocker for hypertension, your cardiologist may recommend avoiding combined oral contraceptives, as they can increase
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