In 2017, Dr. Ryhm Radjef was immersed in the rigors of a cardiology residency at Henry Ford Health when her sister found herself facing a daunting diagnosis: preeclampsia, a grave and sometimes life-threatening condition of elevated blood pressure during pregnancy.
Radjef felt helpless. Her sister had a condition so closely linked to heart health, yet the cardiologist-in-training knew very little about it.
“As a cardiologist, you don’t actually get any special training dealing with anything pregnancy related,” says Radjef, a clinical and noninvasive cardiologist and the director of Henry Ford’s Women’s Heart and Cardio-Obstetrics Program. “You deal with patients all the time, but this is your family member who is crying, asking, ‘What did I do wrong? Why is this happening?’”
Her sister’s ordeal, which led to a premature cesarean section and an extended stay in
the neonatal intensive care unit for the baby, compelled Radjef, a mother of three herself, to reflect on the importance of postpartum blood pressure monitoring.
This personal revelation coincided with a national focus on the relationship between heart disease and pregnancy, revealing a difficult truth: Heart-related complications were the leading cause of maternal mortality in the United States.
So, during the pandemic, Radjef started doing something seldom done in postpartum care: virtual blood pressure monitoring in patients who had recently given birth. In 2023, Radjef took her idea to the next level, launching Henry Ford’s Heart Healthy Moms clinic.
Any patient who experiences blood pressure disorders during pregnancy at Henry Ford is offered enrollment into the program, which allows new mothers to see a nurse virtually every week for four weeks, then every other week until they reach 12 weeks postpartum. The goal is to catch hypertensive issues early so they can be treated.
Cardiovascular conditions cause 33 percent of pregnancy-related deaths, and Black women are about three times more susceptible to pregnancy-related deaths than white women, according to the CDC.
“That number keeps going up,” Radjef says.
Maternal Death and Heart Disease
The profound physiological toll of gestation and delivery on the body requires the heart to work much harder than usual.
From inception, a symphony of changes occurs within the body: Blood volume increases as early as the first few weeks of pregnancy, and most experience a 40-45 percent total increase in blood volume, according to the Cleveland Clinic. Heart rate can increase by 10 to 20 beats per minute and rises steadily until childbirth.
Cardiac output — or the amount of blood your heart pumps each minute — may increase by as much as 50 percent by 28 to 34 weeks of pregnancy, and even more for those pregnant with twins. Signs of heart dysfunction are tricky to pinpoint because many overlap with pregnancy symptoms: fatigue, dizziness, shortness of breath, and heart palpitations.
Those who experience preeclampsia are twice as likely to develop heart disease over their lifetime, according to a 2017 study in the journal Circulation. Patients with no history of hypertension can develop high blood pressure for up to a year after giving birth, researchers have found.
“There’s really a lack of [knowledge of] how obstetric-related conditions can affect the woman’s heart,” Radjef says. “You realize we don’t know enough about what it means now and what it means later for our health.”
An Emerging Field
In the years following Radjef’s initial interest in cardio-obstetrics, she began reaching out to leaders in the field to help lay the foundation for what is now the Heart Healthy Moms clinic.
One of those leaders was Dr. Melinda Baughman Davis, clinical associate professor at the University of Michigan and co-director of the university’s Cardio-Obstetrics Program.
“[Radjef] emailed me in January 2021, and her passion for the field really struck me,” Davis says. “The intersection of the two fields is important for managing this growing patient population. It requires a special expertise to take care of these high-risk patients.”
Radjef, who was born and raised in Algeria and attended medical school there, has just that expertise, says Dr. Bob Rabbani, program director for the Cardiovascular Disease Fellowship at Henry Ford Health, who served as Radjef’s attending physician during her residency. “My first impression of her was she was brilliant,” Rabbani says.
Cardio-obstetrics is becoming its own distinct field within the practice of cardiology, and Rabbani thinks Radjef is “perfectly suited” to be a leader in it. “It’s merging her very distinct clinical and academic expertise in the field of cardiology with her passion for women’s health,” he says.
Heart Healthy Moms
Radjef slowly began developing her vision to create a program that would help patients with adverse pregnancy outcomes — particularly patients with barriers to health care. She secured a grant of $100,000 from the Michigan Health Endowment Fund for the Heart Healthy Moms clinic.
“We decided to break the barriers of child care, transportation, and all the difficulties of getting a brand-new mom to the clinic,” she says. Admission to the clinic happens immediately after giving birth, when at-risk patients are identified by their OB-GYNs. They are supplied with a Bluetooth-enabled blood pressure cuff, which is connected to a portal that allows for communication between patient and doctor.
Push notifications are sent to patients when it’s time to take their blood pressure, and the results go straight from the device to their electronic medical records. In addition to nurses visiting routinely, there’s one comprehensive cardiac assessment at one month postpartum with Radjef.
Virtual blood pressure monitoring has been proved to decrease the likelihood of postpartum complications, including heart attacks, strokes, a blood-clotting condition called disseminated intravascular coagulation, eclampsia, and cardiomyopathy.
“We hope that we will increase awareness of risk factors, help our patients maintain healthy blood pressure after pregnancy, and recognize heart disease early,” Radjef says. “Heart disease and death in pregnant and postpartum women is not talked about enough, and that needs to change.”
This story is from the October 2023 issue of Hour Detroit magazine. Read more in our digital edition.