Angina While Pregnant

Introduction

There are many reasons for angina or chest related pains during pregnancy. Most complaints of chest pain are a part of the natural process of pregnancy; however, chest pains could also highlight a problem that needs treatment. Below are some of the main causes of why you may be suffering from angina pains during pregnancy.

Causes of Angina

One of the main causes of angina is when your heart muscles become more restricted, temporarily restricting the blood and oxygen supply. Here are some of the reasons for this:

• Physical activity
• A stressful environment
• Eating a heavy meal
• Cold weather: Cold weather can cause the blood vessels to limit the amount of oxygen and blood that is pumping around the heart

Common risk factors that can contribute towards angina are:

• Overweight/obesity
• Smoking
• High blood pressure
• Sedentary lifestyle
• Family history of angina
• Age factors
• Other health conditions, such as diabetes

Changes to the Body

Chest pains during pregnancy are usually due to hormonal and physical changes in the body^,,3 Towards the later stages of pregnancy, the growing foetus begins to need more space, which leaves less room for organs, such as the liver, lungs and stomach. This is one of the main causes of angina in pregnancy or why you could be suffering from chest pains. Nevertheless, if you suffer from any type of chest pain, please see a healthcare provider as soon as possible just to ensure a healthy pregnancy.

Anxiety and Stress

Even though pregnancy can be an exciting time, the changes to the female body can be stressful and anxiety-inducing, especially if you are expecting your first child. Anxiety during pregnancy may be the cause of some chest pain symptoms.¹ Anxiety can cause palpitations which can contribute to chest pains. If you are struggling to deal with feelings of anxiety, please seek support by seeing a GP or midwife. 

Indigestion and Heartburn

Indigestion, heartburn, or acid reflux are common causes of chest pain during pregnancy. These are due to both hormonal changes and the discomfort of the growing uterus squashing other organs.² Many people find avoiding spicy meals and foods that trigger indigestion helpful. Additionally, stopping smoking and sitting upright immediately after meals can aid indigestion. Towards the later stages of pregnancy, many people find that eating little and often is more beneficial than eating larger meals.⁴

Lung Conditions in Pregnancy

Lung conditions are common in pregnancy as the immune system is compromised by the extra energy needed to nurture the foetus. Already being diagnosed with asthma and other chronic respiratory conditions can make maternal mothers even more susceptible to conditions: such as pneumonia, bronchitis, and other pregnancy complications. Lung complaints are taken very seriously during pregnancy and treated with medications if required.⁵

Morning Sickness

Experiencing severe morning sickness can lead to chest pains. This is either due to acidic vomit upsetting your throat and/or the repetitive retching exhausting your chest and stomach muscles. If severe morning sickness persists, there are anti-sickness medications available to take during pregnancy that can reduce it.

Breast Pain

Breast pain is a universal symptom of pregnancy, which most women experience, especially in the first trimester when all the hormonal changes are surging through the body, then again in the third trimester when the milk starts to come through. Sometimes breast pain can be mistaken for chest pain. This is known as chest wall pain. This is common for pregnant women due to pressure against the chest from a growing baby. Whilst this is often a harmless symptom, it can be a sign of preeclampsia or coronary issues.³

Rib Pain

Rib pain during pregnancy is usually associated with the third trimester, but it can also start around the time your baby begins to kick. Your baby's foot might even get rooted under your ribs for a short while. To prevent rib cage pain, staying as active as possible is recommended. However, if you experience severe rib pain, mention it to your midwife; occasionally, rib pain can indicate more serious pregnancy health complications and symptoms. 

How to Treat Angina During Pregnancy

Home Remedy Treatment for Angina

Taking over-the-counter medication is not always possible when you are pregnant due to the potential side effects the medication can have on the foetus. Some home remedies to consider for chest pains during pregnancy include: 

• A glass of warm milk with honey
• A small portion of almonds
• Ginger biscuits to relieve nausea may help if the pain is indigestion-related
• A bowl of natural yoghurt
• Chew sugar-free gum
• Have some aniseed
• Have some pineapple or papaya
• Have some Ice cubes or ice chips

Medications used in Pregnancy

Expecting mothers who suffer from angina, high blood pressure, or other heart-related problems have restricted options on which medications they can take due to the risk to the foetus. However, there are some safe and effective options. Healthcare professionals often prescribe nifedipine (calcium channel blockers) to pregnant mothers who have angina, high blood pressure, or other heart conditions.⁷  Some pregnant mothers take a mild dose of aspirin to reduce symptoms. However, every situation is different, depending on the mother and baby's needs. Thus, contact your midwife or GP before taking any non-prescribed medication. 

Serious Pregnancy Complications

Pre-eclampsia 

Pre-eclampsia is a condition seen in the third trimester of pregnancy, often caused by a lack of oxygen supply being delivered to the placenta, thus causing poor blood circulation. This condition can lead to high blood pressure and can be potentially life-threatening if not treated immediately.⁸ 

Symptoms of pre-eclampsia:

• High blood pressure
• Headache/migraine
• High amounts of protein found in urine 
• Problems with vision, such as blurred vision or flashing lights
• Pain below the ribs
• Feelings of anxiety/confusion
• Fatigue
• Sudden swelling of face, feet, or hands
• Vomiting/nausea

HELLP Syndrome

HELLP syndrome is a rare liver and blood clotting disorder that is often compared to a form of preeclampsia. HELLP can be difficult to diagnose because it does not necessarily affect blood pressure or show protein in your urine.⁹

Symptoms of HELLP syndrome

• Visual disturbances, such as blurred vision or flashing lights
• Chest pains/abdomen pain (especially in the upper part or middle right)
• Headache/migraine
• Vomiting/nausea that doesn't stop
• Rapid weight gain and swelling
• Fatigue
• Feeling generally unwell
• Feelings of anxiety/confusion

Pulmonary Embolism

Pregnant women are at a higher risk of being diagnosed with a pulmonary embolism (PE) than any other patient group because of all the changes to the body and decreased blood flow from the veins.¹⁰ A pulmonary embolism is when a blood clot, usually from the leg, manages to travel to the lungs.¹⁰ Even though it is rare, it is a medical emergency that needs urgent attention. 

Peripartum Cardiomyopathy

Peripartum cardiomyopathy is a rare pregnancy complication that develops in the final months of pregnancy. It is a condition where the heart chambers become larger, weakening the heart muscles. Thus, causing blood flow to be restricted, limiting the oxygen supplies to the lungs and all the other internal body systems. Peripartum may be difficult to diagnose because it mirrors the type of symptoms an expectant mother usually experiences during the final trimester.¹¹ 

Symptoms of peripartum cardiomyopathy:

• Swollen ankles
• Chest pressure
• Vomiting/nausea
• Breathlessness/difficulty breathing
• Persistent cough
• Swollen neck veins
• Low blood pressure (drops when standing up)
• Heart palpitations
• Fatigue
• Feelings of anxiety
• Headache/dizziness

When to seek medical advice for chest pain during pregnancy?

Here are some symptoms that require urgent attention:

• Blurry vision
• Shortness of breath
• Severe chest pain/discomfort
• Shortness of breath
• Feelings of pressure/squeezing in the chest area
• Pain or swelling that is noticeable in one leg
• Confusion/disorientation
• Excessive sweating
• Nausea/vomiting that worsens
• Swelling/rapid weight gain
• Change in pallor
• Persistent headache or if headaches worsen significantly
• Feeling generally unwell/fatigue

Risks of Developing Pregnancy Complications

• Being over 35 years of age
• Previous history of complications
• Family history of developing a complication
• Sedentary lifestyle
• Inflammatory disease or other long-term conditions
• Diabetes
• Multiple pregnancies
• Sexually transmitted diseases
• Heart disease
• Being overweight
• Headache

Summary

Even though experiencing chest pains can be common during pregnancy, acknowledging these pregnancy symptoms and sharing them with your healthcare provider is both reassuring and helps them to monitor any potential pregnancy complications.