Krystle Evans still remembers the intense shortness of breath that suddenly made her gasp for air eight months into her pregnancy with twins.
It was on a Saturday in early October and she’d been relaxing in her home in suburban Dallas, Texas, when her chest felt tight. The episode lasted 20 minutes before Evans felt alright again. Perhaps it was just the twins putting pressure on her ribs, she thought.
But on Sunday, when her husband was driving the family back from church, she was once again struggling to breathe.
“I started getting very nauseated. Then my whole left arm went numb,” Evans, 30, told TODAY.
“I was in a whole bunch of pain. My husband said, ‘You need to call the doctor and let him know what’s going on’… I’m so thankful for his wisdom and guidance.”
Evans was told to go to the emergency room immediately. There, based on her symptoms and blood work, doctors told her she likely had two separate heart attacks that weekend, she said.
“I’m very healthy, my family has no history of cardiovascular disease or heart attacks, so this was a big surprise,” Evans noted.
Doctors believe her twins were putting extra stress on her heart, leading to the cardiac event. The amount of blood that the heart of a woman carrying twins pumps in one minute is 15% higher compared to a typical pregnancy, studies have found.
"I think the big fear when people hear a story like this: Every pregnant woman is going to think they're having a heart attack," Dr. Jerry Luciani, Evan’s OB/GYN, told NBC affiliate NBC 5 – KXAS in Fort Worth, Texas.
"It's an extremely rare event, but you really need to pay attention to symptoms like chest pain and tightness and numbness in your arm."
Still, heart attack risk has been on the rise for pregnant women in recent years, perhaps because expectant mothers are now older than in the past, researchers reported last year.
Heart disease is now the leading cause of death in pregnancy and the postpartum period in the U.S., constituting about a quarter of pregnancy-related deaths, according to the American College of Obstetricians and Gynecologists. Expectant women of color and those with lower incomes have higher rates of mortality.
Even though the statistics include some pre-existing heart problems, the rise in maternal deaths is mostly due to heart conditions that can develop “silently and acutely” during or after pregnancy, ACOG warned.
“Pregnancy is a natural stress test,” said Dr. James Martin, chairman of ACOG’s Pregnancy and Heart Disease Task Force, in a statement.
“The cardiovascular system must undergo major changes to its structure to sustain tremendous increases in blood volume.”
In Evans’ case, doctors at Medical City McKinney decided to keep her at the hospital for two weeks under close monitoring. The extra time would give her heart a chance to recover after the cardiac event and her twins a chance to develop more before a scheduled C-section.
Tests showed the fetuses weren’t affected by her heart attacks and she had no heart muscle damage.
Beta blockers lowered Evans’ heart rate to about 100 beats per minute — an improvement over the 150 beats she was experiencing before the ordeal.
She gave birth to a girl and a boy on Oct. 21 at 34 weeks gestation. Shiloh, weighed 5 pounds, 3 ounces; Sage, weighed 5 pounds, 1 ounce. They are still in the neonatal intensive care unit, but are doing great, Evans said.
She is also recovering well and is back at home with her husband, 7-year-old daughter and 2 year-old son. Her cardiologist wants her to follow up, but doesn’t think she’ll have any long-term issues, she said.
Evans wants other pregnant women, especially those carrying multiples, to be aware of heart attack symptoms.
“Stay in tune with your body and listen to your gut,” she said. “And stay positive. That made a big difference in my recovery.”
“Being aware is the biggest take-home message for women,” Dr. Sripal Bangalore, the co-author of last year’s study about heart attack risk for pregnant women and an interventional cardiologist at NYU Langone Health, told TODAY.
The diagnosis can sometimes be a challenge, Bangalore said. For example, pregnant women can have acid reflux and it becomes difficult to distinguish whether it's heartburn due to pregnancy or chest discomfort that may be caused by a heart attack.
Pregnant women should be aware of classic heart attack symptoms
Warning signs include:
- chest pain, chest pressure and discomfort
- lightheadedness, dizziness and nausea
- shortness of breath
- an overall feeling of being uncharacteristically unwell or fatigued.
These classic symptoms apply to pregnant women, too, Bangalore said.