The symptoms I don’t wait on
Chest pain after my first birth, and again in my second pregnancy. What each heart test can and can’t tell you, and why I go in instead of waiting.
Key points
- In CDC’s 2017–2019 review of pregnancy-related deaths from 36 states, cardiac and coronary conditions, cardiomyopathy (disease of the heart muscle) and blood clots together accounted for about 30% of deaths with a known underlying cause. Treat chest pain or trouble breathing as urgent during pregnancy and for a year afterward.
- Pregnancy raises the risk of a blood clot about fivefold, and the risk stays higher for about three months after delivery. Ask your provider about your clot risk, especially after a cesarean.
- The CDC’s urgent maternal warning signs include chest pain, a fast-beating heart and trouble breathing. Say “I’m pregnant” or “I gave birth in the last year” first, every time you call or walk in.
Five days after my first baby was born by cesarean, my blood pressure was up and I had chest pain. I called the hospital’s emergency line, as my discharge papers told me to. Then I wrote to my doctor about what they’d said: “They’re not concerned with the chest pain and said to contact them if it gets very bad (e.g. can’t breath/ I’m in the fetal position).”
I had just been treated for preeclampsia with severe features. I had a newborn and a fresh incision. “If it gets very bad” wasn’t an instruction I knew how to use.
Two pregnancies, two kinds of chest pain
After my first birth. My doctor wrote back that evening, while away until the end of the month, and the answer was clear: “If you are having chest pain also call to discuss those symptoms with the oncall physician – you should go to the emergency room for evaluation if this is still present.” Two people at the same hospital had given me two very different thresholds. My doctor’s was the one I chose to follow.
That wasn’t the first time I’d asked about my chest or my breathing. Earlier in that pregnancy, I had asked about waking up at night with a suffocating feeling, and whether my breathing during sleep should be checked.
In my second pregnancy, the chest pain came first. I was walking home after eating when I felt a sharp, shooting pain in my chest. About an hour later, I went to the hospital. They took my urine first, and a nurse told me I wasn’t pregnant. Later, the doctor told me that was incorrect: I was pregnant. Thankfully, the ECG (a test of the heart’s electrical activity) was normal. A blood test for clots, the D-dimer, was slightly elevated. A few weeks later, during another severe episode, an ECG at urgent care showed abnormalities.
The pain is a pressure, sometimes sharp and stabbing, sometimes running into my shoulder. It comes with nausea, lightheadedness and weakness, and it can get worse after eating, walking or changing position. I stopped running because of it. I can still do Pilates.
My new OB referred me to a cardiologist, and I’ve had ECGs, bloodwork, an echocardiogram, a stress test and a heart monitor. The results have been reassuring. The symptoms haven’t stopped. So I ask two questions about every test: what did this rule out, and what is still unexplained?
What each test can and can’t tell you
Each heart test answers a different question. An ECG records the heart’s electrical activity in that moment. An echocardiogram uses sound waves to show the heart’s chambers, valves and pumping. A stress test watches the heart during exercise, or with medication. A Holter monitor is a portable ECG worn for a day or two during normal activities (Brigham and Women’s Hospital). A troponin blood test checks for a protein that rises when heart muscle is damaged (MedlinePlus). A normal result on one doesn’t answer the questions the others are designed for.
Pregnancy and the weeks after birth raise the risk of blood clots. A clot in the leg, called deep vein thrombosis, can travel to the lungs and cause a pulmonary embolism, which is an emergency. The D-dimer I had in my second pregnancy measures a substance released as blood clots break down. Pregnancy itself can raise the result, so a high result alone does not diagnose a clot; clinicians interpret it with symptoms, risk factors and, when needed, other testing.
Chest pain is one of the CDC’s urgent maternal warning signs, and those signs apply during pregnancy and for a full year after birth.
How I handle it now
- When instructions conflict, I choose the more cautious one, then get it settled in writing. After my first birth, I did that with my chest pain and with my blood pressure thresholds.
- I ask what each test ruled out and what it couldn’t.
- I ask who owns what’s still unexplained. I don’t let a reassuring result end the conversation while the symptom continues. My chest pain is still unexplained, and I’m still asking.
- I lead with “I’m pregnant” whenever I call or walk in.
What else to ask about
- Ask whether you need cardio-obstetric follow-up. Some hospitals have clinics that specialize in heart conditions in pregnancy.
- Ask about your blood clot risk, especially after a cesarean, with reduced mobility or with a history of clots.
- Mention breathing problems at night. Waking up gasping is worth raising, not enduring.
Take this back
To discuss with your care team:
- What did each test rule out, and what could still explain my symptoms?
- Who is following up if this continues?
- Should I see cardiology or a cardio-obstetrics clinic?
- What is my blood clot risk, and is anything recommended to lower it?
- What symptoms mean I should come in right away, and does the after-hours line use the same instructions?
To discuss with the people in your life: If I have chest pain or can’t catch my breath, will you call 911 even if I hesitate?
Don’t wait if
The CDC lists these urgent maternal warning signs, during pregnancy or in the year after birth: a headache that won’t go away or gets worse; dizziness or fainting; changes in vision; a fever of 100.4°F or higher; extreme swelling of the hands or face; trouble breathing; chest pain or a fast-beating heart; severe nausea and vomiting; severe belly pain that doesn’t go away; a baby’s movement stopping or slowing during pregnancy; vaginal bleeding or leaking fluid; severe swelling, redness or pain in a leg or arm; overwhelming tiredness; and thoughts of harming yourself or your baby.
Chest pain that worsens with a breath or cough, coughing up blood, or a racing or irregular heartbeat can signal a clot in the lungs. Call 911.
Next in the series: “Counting Your Baby’s Movements”
