Chest pain in pregnancy

Jump to navigation Jump to search

Chest pain Microchapters


Patient Information


Historical Perspective




Differentiating Chest pain from other Diseases

Epidemiology and Demographics

Risk Factors


Natural History, Complications and Prognosis

Chest Pain in Pregnancy


Diagnostic Study of Choice

History and Symptoms

Physical Examination

Laboratory Findings



Echocardiography and Ultrasound

CT scan


Other Imaging Findings

Other Diagnostic Studies


Medical Therapy



Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Chest pain in pregnancy On the Web

Most recent articles

cited articles

Review articles

CME Programs

Powerpoint slides


Ongoing Trials at Clinical

US National Guidelines Clearinghouse

NICE Guidance

FDA on Chest pain in pregnancy

CDC on Chest pain in pregnancy

Chest pain in pregnancy in the news

Blogs on Chest pain in pregnancy

to Hospitals Treating Chest pain in pregnancy

Risk calculators and risk factors for Chest pain in pregnancy

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]  ; Associate Editor(s)-in-Chief: Nuha Al-Howthi, MD[2]


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.


Life-threatening Causes[1]

Life-threatening causes of chest pain among pregnant women include the following:

    • Diagnosis of AMI in pregnant women include the constellation of symptoms, electrocardiograph, and cardiac markers.[3]
      • 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
    • During pregnancy there is an increase in maternal blood volume, stroke volume, and cardiac output.[1][4]
    • The effect of maternal hormones on remodeling the tunica media and intima of the arterial wall cause increased shear forces on the aortic wall, which begin in the first and second trimesters but are most notable in the third trimester and peripartum.
    • Pre-existing 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, cardiac catheterization, and cocaine exposure are the most common risk factors in aortic dissection occurring in women younger than 45 years.[1][4]

Other Causes

Other causes of chest pain of pregnancy include the following:

Cardiac Testing Considerations for Women Who Are Pregnant, Postpartum, or of Child-Bearing


  1. 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. Roth A, Elkayam U (2008). "Acute myocardial infarction associated with pregnancy". J Am Coll Cardiol. 52 (3): 171–80. doi:10.1016/j.jacc.2008.03.049. PMID 18617065.
  3. McLintic AJ, Pringle SD, Lilley S, Houston AB, Thorburn J (1992). "Electrocardiographic changes during cesarean section under regional anesthesia". Anesth Analg. 74 (1): 51–6. doi:10.1213/00000539-199201000-00009. PMID 1734798.
  4. 4.0 4.1 Manalo-Estrella P, Barker AE (1967). "Histopathologic findings in human aortic media associated with pregnancy". Arch Pathol. 83 (4): 336–41. PMID 4225694.