#67 Chest Pain During Pregnancy

In an earlier blog post, I talked about heartburn in pregnancy. But what about chest pain during pregnancy?

How to manage chest pain in pregnancy depends on your family history, your personal history, your pregnancy history, and how far along you are in labor. If, for example, your cervix is 9 or 10 centimeters dilated, the best thing would be to just get you delivered. If, on the other hand, your cervix is 3 centimeters dilated and you are having chest pains, you should have an EKG and blood tests for troponins and other heart enzymes as well as ultrasound to look for how your heart is contracting and how your heart valves are functioning.

It’s very unlikely for normal labor to cause chest pains. It is extremely unlikely for labor to cause heart attacks or heart failure, but it is possible. There are always times when pregnancy-induced cardiomyopathy shows no physical symptoms. If you have undiagnosed cardiomyopathy it is possible labor could cause heart trouble associated with undiagnosed cardiomyopathy. In the past, cardiomyopathy occurred mostly postpartum, but today we are seeing increased occurrence of cardiomyopathy during pregnancy.

Cardiomyopathy is a very serious problem in pregnancy. The heart muscle cells become week and inflamed. I’ve written about cardiomyopathy in a previous blog post about heart symptoms in pregnancy.

In pregnancy, cardiomyopathy has been a purely pregnancy-related response. Over time, after delivery, the condition often resolves itself. Please note that cardiomyopathy in pregnancy is not caused by diet. We hear today much about avoiding butter, milk, bacon, red meat.  etc. I think we have gone way overboard with these recommendations. More current advice says that eggs are not only safe but also good for you. In many diets, eggs are considered free. They are loaded with vitamins and proteins which are important for your pregnancy diet. I have always felt that a well-balanced meal containing fat, carbohydrates, and protein is particularly important in pregnancy.

Although it is very unlikely to have normal conditions of pregnancy mistaken for preeclampsia, there might be some exceptions. Heartburn could be confused with the right upper quadrant pain of preeclampsia related to liver capsule expansion. Your doctor can diagnose whether or not you have preeclampsia by checking your blood pressure, your reflexes, or your urine for protein. It’s even possible what seems the normal shortness of breath in pregnancy could be caused by a pulmonary embolism. If you have any concerns about your shortness of breath, don’t hesitate to go to the emergency room if you cannot speak with your physician about your concerns.

If you have higher than normal blood pressure and are diagnosed with pre-eclampsia when you are in the hospital for the delivery of your baby, your doctor should keep you in the hospital until your blood pressure and labs return to normal and your blood pressure can be managed at home.

As for possible pre-eclampsia, please remember that 30 percent of preeclampsia cases appear after you have delivered your baby and are home. If you experience chest pain after you are home with your baby, contact your physician immediately. Any chest pain after you deliver should be reported to your doctor.