angina in pregnancy

Overview

Angina is a type of chest pain that happens when the heart does not get enough oxygen. When this happens during pregnancy, it is called angina in pregnancy. It is a serious symptom that needs quick medical help, but with proper care, most women and babies do well.

It is not common. Most chest pain during pregnancy is from heartburn or muscle strain, but angina must be ruled out.

It can affect pregnant women of any age, but you are more at risk if you already have heart disease, high blood pressure, diabetes, or are over 35.

Symptoms

Common symptoms

• Chest pain that feels tight, heavy, or squeezing
• Pain that spreads to your arms, neck, jaw, or back
• Shortness of breath
• Breaking out in a sweat
• Feeling sick or vomiting
• Feeling very tired or lightheaded

Symptoms in children

• This condition affects pregnant adults. If a child has chest pain, call your local emergency number immediately.

Symptoms in older adults

• In older pregnant women, angina may feel less typical, such as breathlessness or extreme tiredness without obvious chest pain.

Causes

Main causes

• A narrowing or blockage in the coronary arteries, which are the blood vessels that feed the heart, due to cholesterol build-up.
• A sudden spasm (tightening) of a coronary artery, which can slow blood flow.
• A tear in the wall of a coronary artery, called coronary artery dissection. This can happen during pregnancy or soon after.
• The extra work your heart does during pregnancy because of increased blood volume and higher pulse.

Risk factors

• Having heart disease before pregnancy
• High blood pressure or pre-eclampsia
• Diabetes
• High cholesterol
• Smoking or using recreational drugs
• Being over 35
• A family history of early heart disease

When to see a doctor

See a doctor urgently if:

• If you have any chest pain that lasts more than a few minutes, is severe, or happens with other symptoms like breathlessness or fainting, call your local emergency number immediately.

Book a routine appointment if:

• If you have a known heart condition and are planning a pregnancy, talk to your doctor beforehand.
• If you are pregnant and have new chest pain that is mild and goes away quickly, still call your doctor or midwife the same day.

Diagnosis

Your doctor will ask about your symptoms, your health history, and your pregnancy. They will listen to your heart and lungs. You may need tests to see how well your heart is working.

Tests that may be done

• Electrocardiogram (ECG or EKG) — a quick test that records the heart's electrical activity.
• Echocardiogram — an ultrasound scan of the heart to check its structure and pumping action.
• Blood tests to look for heart muscle stress.
• Chest X-ray with a protective shield for your baby, if needed.
• Sometimes a CT scan or cardiac catheterization, but only when necessary.

What to expect at your appointment

If angina is suspected, you will likely be admitted to hospital. The team will watch you and your baby. Most tests are safe in pregnancy. You will be involved in every decision.

Treatment

Treatment for angina in pregnancy focuses on improving blood flow to your heart, relieving symptoms, and keeping both you and your baby safe. Your medical team will choose treatments that are safe for pregnancy.

Self-care at home

• Stop and rest when you feel chest pain.
• Sit upright rather than lying flat.
• Take all medicines exactly as prescribed.
• Do not smoke, vape, or use recreational drugs.
• Follow your doctor's advice about physical activity.

Medical treatments

Your care team may use medicines to help blood vessels relax, lower blood pressure, or reduce the risk of blood clots. Any medicine will be selected with your pregnancy in mind. You may also receive oxygen. In rare cases, a procedure to open a blocked artery may be recommended.

When is surgery considered?

Surgery is rarely needed for angina during pregnancy. It may be considered if a severe blockage is found and medicine is not enough. Your team will explain the risks and benefits for you and your baby.

Living with this condition

You may need to slow down and take more rest breaks. Your healthcare team will help you decide a safe activity level. Keep all appointments and tell your doctor if your symptoms change.

Lifestyle tips

• Avoid smoke, including second-hand smoke.
• Eat a heart-healthy diet with vegetables, fruits, whole grains, and lean protein.
• Practice relaxation to reduce stress.
• Attend all prenatal visits.
• Monitor your blood pressure at home if your doctor advises it.

Diet and exercise

Work with your doctor or a dietitian to create a meal plan that is good for your heart and your baby. Gentle walking is often safe, but always ask before starting exercise.

Mental health and emotional wellbeing

Worrying about your heart and your baby is normal. Angina can be scary, and it is okay to feel anxious. Speak openly with your doctor and let them know how you are coping. Your emotional health matters.

Prevention

If you already have heart disease, the best prevention is to get it well controlled before pregnancy. During pregnancy, following your care plan lowers your risk.

Complications

If left untreated

• The angina could lead to a heart attack.
• Poor blood flow could affect the health of the baby.
• The placenta may not get enough blood, which can slow your baby's growth.

Long-term outlook

With early care and treatment, most women with angina in pregnancy can have a safe delivery and a healthy baby. Your healthcare team will support you every step.

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