Palpitations During Pregnancy: What You Need to Know - Obstetrics and Gynecology

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Palpitations during pregnancy can be a common concern for many expectant mothers, especially as the body undergoes significant physiological changes. In your case, experiencing a heart rate of 100-120 beats per minute at 21 weeks of pregnancy, compared to your pre-pregnancy rate of 70-90 beats per minute, can understandably cause anxiety.
Firstly, it is important to note that during pregnancy, the body increases blood volume and cardiac output to support the growing fetus. This can lead to an increase in heart rate, which is often considered a normal physiological response. However, the sensation of palpitations—feeling like your heart is racing, fluttering, or pounding—can be distressing and may sometimes indicate an underlying issue that requires attention.

In your situation, since you have no prior history of cardiovascular disease and your previous ECG was normal, it is likely that the palpitations are benign. However, there are several factors to consider:
1. Hormonal Changes: Pregnancy leads to increased levels of hormones such as progesterone, which can affect heart rate and rhythm. The body also produces more blood to supply oxygen and nutrients to the fetus, which can increase the workload on the heart.

2. Increased Blood Volume: As mentioned, the increase in blood volume can lead to a higher heart rate. This is a normal adaptation, but it can sometimes cause discomfort or the sensation of palpitations.

3. Anxiety and Stress: Emotional factors can also contribute to palpitations. Pregnancy can be a time of heightened emotions and stress, which can lead to increased heart rates.

4. Dehydration or Electrolyte Imbalance: Ensure you are well-hydrated and consuming a balanced diet rich in essential nutrients. Dehydration or imbalances in electrolytes (like potassium and magnesium) can lead to palpitations.

5. Physical Activity: Increased physical activity or exertion can also lead to a higher heart rate. If you have recently increased your activity level, this could be a contributing factor.

6. Other Medical Conditions: Conditions such as anemia, thyroid disorders, or even infections can lead to increased heart rates and palpitations. It is essential to rule these out, especially if you experience additional symptoms like shortness of breath, chest pain, or dizziness.

Given your symptoms of chest tightness and occasional shortness of breath, it is advisable to consult with your healthcare provider. They may recommend further evaluation, such as a physical examination, blood tests, or possibly a Holter monitor to assess your heart rhythm over a 24-hour period.
In terms of impact on the baby, if the palpitations are benign and not associated with any underlying heart disease or significant maternal distress, they are unlikely to affect fetal well-being. However, it is crucial to monitor your symptoms closely and communicate any changes to your healthcare provider.

In summary, while palpitations can be a normal part of pregnancy, it is essential to stay vigilant and seek medical advice if you have concerns. Regular prenatal check-ups are vital for monitoring both maternal and fetal health, and your healthcare provider can offer the best guidance tailored to your specific situation. Remember to maintain a healthy lifestyle, manage stress, and stay hydrated, which can all contribute to a more comfortable pregnancy experience.