Chest pain in pregnancy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Nuha Al-Howthi, MD[2]
Overview
Causes of chest pain in pregnancy are similar to those in the general population. Acute life-threatening causes include myocardial infarction, aortic dissection, tension pneumothorax, as well as thromboembolic diseases that are more common in pregnancy, such as pulmonary embolism and amniotic fluid embolism. Occasionally, chest pain in pregnant women is caused by physiological changes in pregnancy, namely chest expansion and breast tenderness.
Causes
Life-threatening Causes[1]
Life-threatening causes of chest pain among pregnant women include the following:
- Acute MI: pregnancy has been shown to increase the risk of myocardial infarction(MI) 3- to 4-fold
- The causes range from coronary dissection, to vasospasm, to acute plaque rupture. AMI can occur during any stage of pregnancy but is most common in the third trimester and in the 6-week period after delivery,occurring mostly in multigravidas, most patients being older than 30 years.
- Risk Factors associated with AMI in pregnancy are Maternal age greater than 35 years, Hypertension, Diabetes mellitus.
- Atherosclerotic plaque rupture: Common in antepartum period
- Coronary dissection: Common in peripartum or postpartum period
- The cause is Coronary atherosclerosis with or without thrombus, coronary artery dissection, spasm, emboli, and normal coronary arteries.
- Diagnosis of AMI in pregnant women include the constellation of symptoms, electrocardiograph, and cardiac markers.
- The diagnostic approach is influenced by fetal safety and normal changes during pregnancy.
- Electrocardiograms (ECGs) done during normal pregnancy frequently show a left or right axis deviation, a small Q in lead III, nonspecific T-wave inversions, or an increased R/S ratio in leadsV1 and V2, which can make the ECG diagnosis of ischemia in acute coronary syndromes more challenging.
- Aortic dissection and other aortic syndromes
- The effect of maternal hormones on remodeling the tunica media and intima of the arterial wall cause increased shear forces on the aortic wall, these changes begin in the first and second trimesters but are most notable in the third trimester and peripartum.
- Preexisting risk factors such as premature atherosclerosis and arterial hypertension,hereditary connective tissue disease such as MFS and Ehlers-Danlos syndrome, previous aortic surgery, bicuspid aortic valve disease, aortitis, surgical manipulation, car-diac catheterization, and cocaine exposure asthe most common risk factors in aortic dissec-tion occurring in women younger than 45years.[1][2]
Other Causes
Other causes of chest pain of pregnancy include the following:
- Asthma exacerbation
- Pneumonia
- Pneumothorax
- TB reactivation
- Gastroesophageal reflux disease
- Vasospasm
- Myocarditis
- Pericarditis
- Endocarditis
- Trauma
- Sarcoidosis
- Severe kyphoscoliosis
- Chest expansion (usually physiological change)
- Breast tenderness (usually physiological change)
References
- ↑ 1.0 1.1 1.2 Sahni, Gagan (2012). "Chest Pain Syndromes in Pregnancy". Cardiology Clinics. 30 (3): 343–367. doi:10.1016/j.ccl.2012.04.008. ISSN 0733-8651.
- ↑ 2.0 2.1 Manalo-Estrella P, Barker AE (1967). "Histopathologic findings in human aortic media associated with pregnancy". Arch Pathol. 83 (4): 336–41. PMID 4225694.