Youth and beauty 

Can the chest hurt in pregnant women. Causes outside the chest. What Not to Do

As a rule, most pregnant women begin to feel similar symptoms towards the end of the second - the beginning of the third trimester and it is caused purely physiological processes, invariably occurring in the body as the fetus grows.

At the same time, the state when it presses under the breast during pregnancy does not necessarily have to be felt by every woman, because it directly depends not only on the size of the fetus, but also internal location uterus relative to the abdominal walls (distinguish between internal and external). So, if the uterus is too close to the anterior abdominal wall, then as the unborn child grows, it begins not only to contribute to a significant displacement of all internal organs, which is quite natural process, but also exert strong pressure on the diaphragm and bone tissue, which creates the feeling that a rib hurts under the breast during pregnancy. Moreover, a painful syndrome is not the only negative aspect of such rearrangements in the body, directly related to interesting position women, because, among other things, pressure on the diaphragm, ribs and, as a result, soft tissues anterior wall of the abdomen, accompanied by such most unpleasant moments like itching, swelling and even hidden hematomas.

Most common in pregnant women with similar problems can be seen very big tummy, well, if we are talking about multiple pregnancy, then, unfortunately, it is unlikely that it will be possible to avoid such discomfort. Moreover, often, when such symptoms are aggravated by poor physical health, which makes itself felt especially strongly at those moments when a woman is in an exceptionally horizontal position(meaning a perfectly flat surface without soft pillows or mattress). So, for example, many expectant mothers begin to feel an acute malaise during the ultrasound procedure (ultrasound examination of the fetus and placenta) and often when it ends in a loss of consciousness. Doctors call this phenomenon vena cava syndrome and just the same, they explain it by the strong pressure of the fetus on the diaphragm.

It also happens that, along with the fact that the rib under the breast hurts during pregnancy, the woman begins to feel a strong bursting in the area chest and all the bras become small in volume to her. These symptoms are due to temporary deformities of the joints and usually within a few days/weeks after childbirth, everything falls into place. In order to somehow facilitate your existence in the last few months of pregnancy, experts recommend wearing a special frameless underwear, which provides a wide strip under the cups of the bodice and completely eliminates the use of supporting bones. An additional convenience of such bras is that they are usually equipped with special girth regulators, which can be used if the size of the breast stops changing, and the volume of the chest continues to expand. Such underwear, by the way, will come in handy during breastfeeding, especially if its cups are equipped with special buttons that allow you to take the chest out at any time without removing the bodice itself.

It also happens that a pregnant woman begins to experience severe pain and heaviness under her breasts due to her incorrect posture (meaning various pathologies and curvatures in which the internal displacement of organs is difficult or occurs according to completely different patterns, non-standard for this phenomenon). There is only one way out of this situation - to monitor your posture and recline as often as possible on a vertical flat surface, whether it be a wall or the back of a chair, thereby unloading your spine, diaphragm and chest to the maximum by shifting the center of gravity. Ideally, of course, it is worth choosing a special bandage for the abdomen or sewing it from highly qualified specialists according to individual sizes, taking into account all the structural features. This device will help support the stomach from below and at the same time keep it from pushing up, thereby reducing pressure on the diaphragm and chest as a whole.

You can help yourself to "unload" and with the help of special exercises. One of them is that a woman should become in a knee-elbow position and begin to arch up and, accordingly, bend down like a cat. Usually five to ten minutes of such simple manipulations are enough to lower the pain threshold or at least temporarily eliminate others. discomfort associated with this phenomenon. It is not uncommon when heaviness in the chest partially or completely disappears somewhere from the 35th week, when the woman is already, as they say, at the finish line. This is because as we approach birth process, the tummy itself begins to sink down, thereby reducing the pressure on the diaphragm and ribs. In this case, on the contrary, the center of gravity may shift down and this time they will begin to make themselves felt. pelvic bones, although the latter symptomatology is not at all obligatory.

And even if there is no significant relief before childbirth, do not despair, because all the difficulties and not very comfortable moments will be forgotten immediately after the baby is born and mommy will have to take care of completely different problems.

Sometimes, in order to speed up the postpartum recovery process, a woman is recommended to use a special corset that will help in as soon as possible tighten the stretched muscles of the anterior wall abdominal cavity, and also lead to original view chest, which often during pregnancy lends itself to quite serious deformations and displacements.

The differential diagnosis of chest pain in pregnant women is the same as in non-pregnant women. Causes can be cardiovascular, pulmonary, gastrointestinal, neuromusculoskeletal, and psychogenic (Box 1). Although chest pains of cardiopulmonary etiology are rare, they lead to high mortality during pregnancy, so they are ruled out in the first place. This section focuses primarily on the vital dangerous reasons chest pain during pregnancy.

During pregnancy, it is necessary to exclude benign, but more common causes chest pains such as musculoskeletal and gastrointestinal. Most women with heart disease tolerate pregnancy well, and most cardiologists and obstetrician-gynecologists currently see a small number of such women. Women with known or suspected heart disease, vague chest pain associated with other pregnancy symptoms, or women planning a pregnancy should be referred to specialized center. Optimal management of pregnant women with known, suspected or newly diagnosed heart disease provides a multidisciplinary approach involving experienced cardiologists working in collaboration with obstetrician-gynecologists, anesthesiologists, clinical geneticists and neonatologists.

Differential diagnosis of chest pain during pregnancy

Cardiac causes

Ischemic

  • Acute coronary syndrome
  • coronary atherosclerosis
    • coronary spasm
    • dissection of the coronary arteries
    • thrombosis of the coronary arteries
  • Arteritis of the coronary arteries

Non-ischemic

  • Aortic dissection
  • Pericarditis
  • Mitral valve prolapse

Non-cardiac causes

Pulmonary

  • Embolism pulmonary artery/heart attack
  • Pneumothorax
  • Pneumonia with pleural effusion

Gastrointestinal

  • Spasm of the esophagus
  • Esophageal reflux
  • Rupture of the esophagus
  • peptic ulcer

Neuromuscular skeletal

  • Cervical lesions/ thoracic spine
  • Rib dystrophy/Tietze's syndrome
  • Shingles
  • Pain in the chest wall
  • Pleurisy

Psychogenic

  • Anxiety
  • Depression
  • Cardiac psychosis

Coronary artery disease

Acute myocardial infarction (MI) is the most common form acute coronary syndrome - rare in pregnant women. Its frequency is 1:10,000 pregnancies. The incidence of MI during pregnancy may increase, reflecting a trend towards increasing maternal age. Mortality from myocardial infarction during pregnancy is usually 37-50%. The risk of death is highest if a MI occurs in late pregnancy in a woman older than 35 years or if she gives birth within 2 weeks of MI.

At normal pregnancy, childbirth and delivery, the level of cardiac troponin I does not change. Therefore, its definition is the method of choice for the diagnosis of acute coronary syndrome. Due to the highest risk of bleeding, thrombolysis is contraindicated within 10 days after caesarean section and when premature birth in later dates pregnancy. The best choice- primary angioplasty, but there are no data on the methods of such treatment. Need to weigh the risk maternal mortality regarding the risk of radiation exposure, the use of antiplatelet drugs and intracoronary thrombolysis.

Women with diagnosed coronary heart disease should be evaluated and treated before conception. Spasm of the coronary arteries, coronary thrombosis and dissection of the coronary arteries are more common than atherosclerotic ischemic disease hearts.

Spontaneous dissection of a coronary artery

Sudden severe chest pain in a previously healthy pregnant woman may be caused by a coronary artery dissection. Thrombolysis is not indicated, but urgent coronary angiography performed for primary angioplasty with stenting improves survival. Dissection occurs in one or more coronary arteries, and indications for intervention depend on the location and true size of the developing infarction.

Coronary Arteritis and In Situ Thrombosis

Long-term Kawasaki disease leads to coronary arteritis with aneurysm formation. In pregnancy, thrombosis is manifested by angina pectoris or MI, and there is a need for coronary artery bypass grafting. Arteritis of the coronary arteries is associated with ongoing autoimmune vascular disease, and during pregnancy or in postpartum period it can also cause a heart attack. To identify the mechanism of occurrence, localization of a heart attack and appointment adequate treatment plays an important role coronary angiography. Arteritis of the coronary arteries usually occurs in the postpartum period, and in heart failure it must be differentiated from postpartum cardiomyopathy.

Non-ischemic causes

Mitral valve prolapse is the most common congenital heart disease and is diagnosed frequently in young women. childbearing age. The disease usually presents with atypical chest pain and a systolic murmur with an accompanying mid-systolic click. The treatment of this disease during pregnancy is poorly understood. Women with normal hearts tolerate pregnancy well and do not develop further cardiac complications. Moreover, the incidence of antenatal and intranatal complications or signs of fetal distress is not higher than in pregnant women with no cardiac pathology. Patients with moderate to severe mitral regurgitation are indicated for mandatory antibiotic prophylaxis and regular ECG monitoring.

Aortic dissection

Acute aortic dissection - a sudden rupture of the intima, allowing blood flow to exit the lumen of the vessel, which leads to the rapid separation of the inner and outer layers. Patients with Marfan syndrome are at high risk of aortic dissection due to an abnormal amount of microfibers in the aortic tissue, leading to progressive weakness of the middle layer of the aortic wall. The parietal pericardium is adjacent to the ascending aorta just proximal to the origin of the innominate artery. Rupture of any part of the ascending aorta leads to hemorrhage into the pericardial cavity. The resulting hemopericardium is the cause of instant death. Dissections of the aortic arch are more complex.

Symptoms and signs

Aortic dissection during pregnancy is rare and is not initially diagnosed because its symptoms are similar to those of incipient labor. Pregnant women often feel discomfort in the epigastrium, which they define as a burning sensation in the chest. However, this symptom is uncharacteristic for the onset of labor, a burning sensation in the chest can be early symptom aortic dissection. Important differential diagnostic signs of aortic dissection and incipient labor are different blood pressure in the arms and different filling of the pulse in the radial arteries, the sudden appearance of a diastolic murmur in the aorta and increased chest pain.

Diagnosis and treatment

On x-ray, acute aortic dissection appears as an enlargement of the mediastinum, especially in its upper section and towards the left half of the chest. A common radiographic finding in patients with ascending aortic dissection is cardiomegaly and pericardial effusion. Echocardiography is required to assess left ventricular function, aortic valve consistency, and aortic root size. However, chest x-ray and echocardiogram are not sufficient to accurately diagnose aortic dissection. CT scan is the method of choice for the emergency diagnosis of aortic dissection.

After an accurate diagnosis, the operation of choice is the restoration of the defect with a complex graft. Saving the aortic valve or replacing it with a homograft eliminates the need for long-term use anticoagulants. The risk to the fetus is reduced by normothermic shunting, intravaginal progesterone, and continuous monitoring of the fetal heart.

Acute aortic dissection distal to the left subclavian artery without extension to the proximal aorta is treated conservatively. Surgical intervention this is usually not required, observation with periodic MRI is indicated. Indications for surgical treatment progressive aortic dilatation up to 5 cm or more, recurrent pain or symptoms of acute dissection, such as the development of organ or limb ischemia. If the baby is alive, delivery by caesarean section is performed before bypass surgery. Anesthesia allowance for caesarean section with subsequent treatment of aortic dissection should minimize the effect of depressant drugs on the fetus, while ensuring well-controlled hemodynamics in the mother. Pregnant women with Marfan syndrome are classified as high risk. A favorable outcome depends on prompt diagnosis and referral to a specialist centre.

Pulmonary embolism

Pregnancy - important factor the risk of venous thrombosis. In pregnancy, venous thromboembolism is the leading immediate cause of preventable death. Diagnostics venous thromboembolism complicated by the fact that in pregnant women shortness of breath and swelling of the lower extremities are relatively frequent complaints. Physicians should have a high alertness for this disease and quickly use X-ray methods in the appropriate sequence. Diagnosis of deep vein thrombosis of the lower extremities with Doppler ultrasound does not pose a risk to the health of the fetus, the use of radiographic methods is accompanied by a low risk of irradiation of the fetus. Clinicians should actively look for objective evidence of venous thromboembolism. Anticoagulant treatment poses a greater risk to the mother and fetus than the radiation dose received in the diagnosis of pulmonary embolism. Immediately after diagnosis in the antenatal period, anticoagulant treatment is carried out with intravenous administration of unfractionated heparin or subcutaneous administration of low molecular weight heparin sodium (heparin), with the transition to warfarin treatment in the postpartum period.

Causes of non-cardiac chest pain

The term "non-specific" is very often used in cases where no other disease can be established. It may be associated with anxiety and depression.

To diagnose the cause of chest pain, it is very important to know the anatomy and physiology of the chest, especially its innervation. In diseases that involve only the lung parenchyma, such as interstitial lung disease, there is no chest pain because the lungs have no pain afferent innervation. Chest pain from intrathoracic causes occurs when the pleura is affected. Pneumonia causes chest pain when inflammation spreads to the pleura, often accompanied by a pleural effusion, although this may be small and difficult to detect. The pain is due to inflammation of the parietal pleura and not to the fluid itself.

More likely causes of pain

  • Unexplained, "non-specific"

chest wall

  • Intercostal myalgia/neuralgia
  • Crick
  • Costochondritis
  • Injury ± rib fracture
  • Mastalgia
  • Shingles
  • Abscesses chest wall(eg, staphylococcal, tuberculosis)
  • cocaine overdose

Pleura

  • Pneumonia
  • Infection not seen on x-ray (eg, viral pleurisy, including Bornholm's disease)
  • Pleural effusion due to pneumonia or tuberculosis
  • Pneumothorax
  • Pulmonary embolism
  • Acute sickle cell chest syndrome

Mediastinum

  • Esophageal reflux
  • Spasm of the esophagus

Out of the chest

  • peptic ulcer

Less likely causes of pain

chest wall

  • Tietze syndrome
  • Myositis of the intercostal muscles
  • Osteoarthritis of the cervical or thoracic spine; thoracic disc injury
  • Fracture of the vertebrae or sternum + osteoporosis or osteomalacia

Pleura

  • Pleural effusion in rheumatoid disease, lymphangioleiomyomatosis, cancer (eg, choriocarcinoma, breast cancer) Empyema Hemothorax
  • Pneumomediastinum
  • Connective tissue diseases

Mediastinum

  • Mediastinitis (eg, spontaneous or resulting from rupture of the esophagus)
  • aortic aneurysm
  • Mediastinal tumor (eg, lymphoma)

Out of the chest

  • Kidneys: pyelonephritis, urolithiasis
  • Gallbladder disease (eg, acute cholecystitis)
  • Liver disease (such as hepatitis)
  • Acute and chronic pancreatitis

chest wall

Intercostal neuralgia, muscle strain and osteochondritis diagnosed only by clinical symptoms after the exclusion of a more serious pathology. There are no laboratory or radiological studies confirming these diseases. Diagnosis is based solely on the history and examination, in particular on a normal chest x-ray. Data on the prevalence of these diseases during pregnancy are not available. Chondritis is a very common disorder in the general population, presenting with pain and tenderness primarily in the anterior upper chest wall. Tietze's syndrome is a rare form of chondritis, manifested by chest pain due to inflammatory infiltration of the costocartilaginous joints.

Shingles- rash caused by the Varicella zoster virus reactivating in the dorsal ganglia after previous infection with the virus chicken pox, causes severe pain in the area of ​​the chest wall. Pain persists after the primary lesions subside; postherpetic neuralgia, which occurs in approximately 20% of cases for unknown reasons, although important role psychosocial factors may play a role. Usually shingles lesions are visible in the affected dermatome, but the pain precedes the lesions and persists after they disappear.

Pleura

Viral pleurisy- widespread disease; diagnosis is based on the exclusion of other causes in association with a history of rhinitis or flu-like symptoms—fever, sore throat, generalized arthralgia/myalgia, malaise, and cough. On examination, they reveal high temperature and sometimes a pleural friction rub, which is usually best heard in the lower lateral chest. Bornholm disease, a viral pleurisy with sudden onset of pleuritic chest pain and high fever, is usually caused by Coxsackievirus type B. The patient often experiences severe chest wall pain on palpation, which may be associated with pericarditis/myocarditis. Virological diagnosis is based on the examination of throat swabs, feces, and paired serum samples taken at least 10 days apart. By this time, the patient is likely to have recovered. Therefore, the diagnosis is usually made on the basis of clinical symptoms.

Clinical manifestations pneumonia- shortness of breath, cough with sputum and fever. During a physical examination, a high temperature is usually determined, during auscultation - moist rales, bronchial breathing - with extensive compaction.

At pulmonary embolism due to infarction of the edge of the lung (often ending in wedge-shaped necrosis), extending to the pleura, pain in the lateral chest may occur. Pain in the center of the chest due to pulmonary embolism has the same etiology, but may be caused by angina pectoris due to right ventricular distension. The most common symptom of pulmonary embolism - shortness of breath with hemoptysis - occurs in only 9% of cases. Symptoms found during clinical examination, depend on the size of the embolus. With a large embolus, rapid breathing, tachycardia, cyanosis, hypotension, and an accent of the second heart sound are usually determined. Observe edema lower limb from typical features deep vein thrombosis, in 85% of cases - on the left. The diagnosis is established on the basis of radiological data of ventilation-perfusion scanning (V/Q). A negative test for the presence of D-dimers excludes pulmonary embolism or deep vein thrombosis.

Acute chest syndrome in sickle cell anemia causes severe chest pain, usually in the lateral chest. Often this pain is not of pleuritic origin. These patients are diagnosed with sickle cell disease and present with crisis symptoms, the main symptom of which is pain, especially in the extremities. The main cause of chest pain is a pulmonary embolism (thrombus, adipose tissue or bone marrow) and infection. It is found only in 38% of patients. Infection respiratory tract usually - Chlamydia pneumoniae, Mycoplasma pneumonia, respiratory syncytial virus and many other microorganisms. Pathogens are detected in a serological blood test, and the results are received too late, they do not affect the treatment. Acute respiratory failure occurs in 13% of patients. Fat embolism is diagnosed by the presence of fat-containing macrophages in the sputum or by bronchial contents obtained by bronchoscopy, but this is only possible in intubated patients.

Pain tuberculous pleurisy occurs with tuberculous lesions of the pleura, with the formation of pleural effusion. Typical symptoms are fever, weight loss, and night sweats. During pregnancy, it is difficult to detect a decrease in body weight, but with an increase in the duration of pregnancy, a significant lack of weight gain is noted. Shortness of breath depends on the amount of effusion. If tuberculosis is limited to the pleural cavity, it is considered a closed, non-contagious form. However, when coughing up sputum or hemoptysis, an open, contagious form of tuberculosis is likely, and this means significant damage to the lungs. Physical examination reveals dullness on percussion and muting. Diagnosis of pleural tuberculosis is usually based on a pleural biopsy. Plain aspirate smears from the pleural cavity are rarely positive (acid-fast rods visible on direct microscopy of the fluid) and cultures are often negative. With a biopsy of the pleura, the frequency positive results reaches at least 60%, with biopsy culture - 90%.

Pneumothrax usually presents with sudden pleuritic chest pain and shortness of breath. The pain often subsides very quickly, since it is probably associated with a sudden detachment of the parietal pleura from the chest wall. Primary spontaneous pneumothorax can occur in anyone, it is 9-22 times more common in smokers, and usually in individuals tall And asthenic physique. In women, the incidence of primary spontaneous pneumothorax is 1.2/100,000. In men, this disease occurs 7 times more often, so the incidence during pregnancy is low.

During childbirth, vigorous repeated Valsalva maneuvers theoretically increase the risk of rupture of the subpleural vesicle (small bulla-like structure) - the main cause of spontaneous pneumothorax. There are no other reasons for the increase in the prevalence of pneumothorax during pregnancy. Clinical diagnosis is difficult because, on physical examination, a high-pitched tympanic sound on percussion and significant attenuation of breath sounds on the affected side occur only when there is enough large sizes pneumothorax. In practice, tracheal deviation is often difficult to establish and occurs only in very large "tense" pneumothoraxes. For diagnosis, chest x-ray plays an essential role, it should be described experienced doctor because a small pneumothorax is easy to see.

Described during pregnancy pneumomediastinum which may present with chest pain and shortness of breath. This disease is even rarer than pneumothorax, although if there is one underlying cause, the two diseases can coexist. Pneumomediastinum may result from rupture of the esophagus and has been described in connection with indomitable vomiting pregnant. On palpation of the upper half of the chest and neck, subcutaneous emphysema is determined, causing a crunch under the fingers, and the same sound is heard on auscultation of the chest.

Pleural empyema manifests as pleuritic or nonspecific chest pain and more often occurs as a complication of pneumonia, developing from a normal parapneumonic effusion. With immunosuppression, the likelihood of developing the disease is higher. The symptoms of pneumonia during pregnancy are well described, but there are no observations or individual case histories of pleural empyema during pregnancy. Usually, the history indicates a general malaise for several weeks, fatigue, fever, chest pain and shortness of breath, sometimes preceded by a chest infection or pneumonia. Existing weight loss during pregnancy is difficult to determine. Physical examination reveals symptoms similar to a pleural effusion, with dullness on percussion and muffled or absent breath sounds over the affected area. Empyema may be encysted, in which case the symptoms will be less typical. A chest x-ray shows a picture similar to a pleural effusion. However, when it is encapsulated, an accumulation of fluid is detected, which is atypical for a simple effusion. chest ultrasound - useful method detection of encapsulated fluid, assessment of its amount and subsequent drainage. Simple aspiration of the fluid with a syringe is important for diagnosis, and pus can be detected, but for the diagnosis of empyema, the fluid does not always contain a significant amount of pus. It is necessary to determine the pH of the liquid. pH value<7,2 - показание к дренированию полости эмпиемы.

Diffuse connective tissue diseases- can cause pleural effusion accompanied by chest pain, but such an effusion is often accompanied by shortness of breath without pain. Connective tissue disease is usually diagnosed before pregnancy and is therefore a very likely or probable cause of the effusion. Sometimes one of these diseases is first manifested by pleurisy and can occur during pregnancy, especially since such diseases are more common in young women. A woman can tell herself about the presence of a history of arthralgia, rash and dry eyes. To confirm the diagnosis, a pleural fluid and blood aspirate is analyzed for the appropriate autoantibodies (rheumatoid factor, antinuclear factor, Ro and La antibodies).

Malignant tumors chest during pregnancy is rare. When the pleura is affected, shortness of breath is more common than chest pain. Pleural effusion occurs when the visceral pleura, which has no innervation, and / or blockade of the lymphatic vessels is affected. Breast cancer is the most common malignant tumor in young women, often metastasizing to the bones or pleura. Bronchial cancer is a rare disease that usually occurs in the second half of life at an age when most women are almost unable to become pregnant. Chest pain from any malignant tumor of the chest is most likely caused by metastases to the ribs. In this case, the patient experiences constant, often severe pain that disturbs sleep.

Mediastinum

Extremely common during pregnancy esophageal reflux which can cause chest pain. It is usually manifested by heartburn - a burning sensation in the center of the chest, worse after eating. Reflux occurs in 2/3 of women due to relaxation of the gastroesophageal sphincter due to high levels of progesterone. Drinking alcohol and smoking exacerbate the situation. However, the manifestations of heartburn in women are different, and they may complain of chest pain that is indistinguishable from other causes. Diagnosis is possible only by clinical signs.

Causes outside the chest

In pregnant women peptic ulcer are rare, but instead of pain in the upper abdomen, the disease manifests itself as pain in the lower chest. In the absence of the effect of taking medications or with complications, an endoscopic examination is performed (see Epigastric pain during pregnancy).

Sometimes pain in the lower chest occurs with another pathology of the abdominal organs - cholecystitis, kidney stones, pyelonephritis or acute pancreatitis, which leads to diagnostic difficulties. One of these diseases can be suspected if there is a history of typical symptoms - pain that occurs a short time after eating with cholelithiasis (GSD); fever and / or chills with cholecystitis and pyelonephritis; frequent urination, dysuria and hematuria in pyelonephritis and sometimes in KSD; cramping pain with kidney and gallstones, or with possible triggers for acute pancreatitis, such as alcohol or gallstones.

Anamnesis - the main features that you need to pay attention to

History of complaints

  • Duration, onset, strength, origin and irradiation of chest pains.
  • Association of pain with eating.
  • Factors that increase or decrease pain.
  • Dyspnea.
  • Cough, sputum, hemoptysis.
  • Fever, weight loss.
  • Arthralgia, myalgia, tonsillitis.
  • Trauma, such as a fall.
  • Pain in the legs.

Mental disorders

  • Symptoms of anxiety or depression.

Previous medical history

  • Tuberculosis or contact with a tuberculosis patient.
  • Thrombosis or embolism, such as deep vein thrombosis in a previous pregnancy.
  • Sickle cell anemia.
  • Immunosuppression, HIV.
  • Asthma.
  • Chickenpox.
  • Shingles.

Medications

  • Prednisolone.
  • Taking oral contraceptives.

Family history

  • Blood coagulation disorders.
  • Tuberculosis.

Social history

  • Smoking, ethnicity, travel history, contact with a TB patient.

Physical examination - key symptoms to look for

  • General examination: fever, sweating, cyanosis, lymphadenopathy, jaundice, anemia, hyperemia of the pharynx, symptoms of collagenosis.
  • Cardiovascular system: tachycardia, hypotension, increased pressure in the jugular veins, parasternal bulging, loud II heart sound, pericardial rub.
  • Respiratory system: increased respiratory rate, chest wall tenderness, chest wall tumors, tracheal displacement, dullness on percussion, moist rales, bronchial breathing, muffled or absent breath sounds on auscultation.
  • Mammary glands: tumors.
  • Abdomen: right upper quadrant, epigastric or lower back pain, enlarged liver.

Research methods

Chest X-ray plays a central or key role in the diagnosis or exclusion of important diseases such as pneumonia and pleural effusion. In this case, the exposure is negligible. Pulmonary embolism cannot be accurately diagnosed without a V/Q scan. The consequences of misdiagnosis represent significantly worse outcomes than the negligible risk to the fetus from these studies. If a pathology of the abdominal cavity is suspected, the method of first choice is ultrasound.

Non-cardiac causes of chest pain during pregnancy are almost the same as in non-pregnant women. The most common causes are nonspecific, and often no definite etiology can be established. More serious causes are diagnosed based on history, physical examination, and simple tests.

The mammary glands of a pregnant woman change under the influence of estrogen and progesterone. Hormones cause the breasts to enlarge, swell and swell, increase the sensitivity of the skin and nipples, dilate the milk ducts and activate areas responsible for lactation. The whole process can be accompanied by discomfort that lasts from several weeks to several months. We understand what kind of pain is the norm, and what symptoms indicate a pathology and are the reason for an additional examination.

Pain in the first trimester

Discomfort in the mammary glands may appear in the early stages of pregnancy. As soon as the egg attaches to the endometrium, the concentration of progesterone in the body will increase. The hormone expands the milk ducts and blood vessels, so the breast swells, swells, and a network of veins appears on its surface.

Progesterone also makes the mammary glands more rounded and heavy, and the nipples more tender and sensitive to any touch. The skin may take on a bluish tint, and discomfort often extends to Spence's tail, the area near the armpit.

Attachment of the egg and an increase in progesterone occurs in the second half of the menstrual cycle, most often on days 18–22. Around the same time, there are pains in the mammary glands.

Many girls attribute chest discomfort in the early stages to PMS. But in a pregnant woman, pain in the mammary glands is accompanied not only by swelling and hypersensitivity. She also has:

  • the size of the nipples increases;
  • areolas darken;
  • breast grows;
  • Montgomery tubercles form on the areoles.

Pain in the mammary glands disappears or decreases towards the end of the first trimester, when the body adapts to hormonal changes.

Discomfort in the second and third trimester

Toward the middle or end of the second trimester, preparation for lactation begins. Increases the level of prolactin, which is responsible for the production of colostrum. Adipose tissue replaces the connective tissue, and the milk ducts expand even more.

At 15–20 weeks, a woman may feel that her mammary glands have become more voluminous and have increased by 1–2 sizes. The nipples stretched out, and uncomfortable sensations appeared in the chest again. For many pregnant women, pain in the second and third trimester is not as intense as in the first. It occurs immediately after waking up, but in the evening it subsides and becomes almost invisible.

Discomfort in the second trimester does not appear in all women. In some patients, the breast changes and grows without pain. Discomfort occurs a few weeks before delivery or a few days after, when colostrum begins to be produced.

How long does the chest hurt

Breast tenderness may persist for one, three, or all nine months. In some women, discomfort disappears at 11-13 weeks, when the placenta is activated. The shell in which the fetus develops actively absorbs progesterone, so its concentration in the blood decreases slightly, and unpleasant symptoms disappear.

In other pregnant women, the chest stops hurting just before the birth. And in the second or third trimester, burning, dryness, itching in the nipples and stretch marks are added to the aching or dull pain. Symptoms appear due to the active growth of adipose tissue. It stretches the skin too quickly, so the dermis does not have time to adapt to the changes, and discomfort occurs.

The pain disappears towards the end of the second trimester or by the middle of the third, when the woman begins to produce colostrum. Milk production is a signal that the breast has completely rebuilt and is ready for lactation.

Do breasts always hurt during pregnancy

The mammary glands do not hurt in all pregnant women. The breast can develop and grow without discomfort. In some women, the sensitivity of the nipples simply increases and a venous network appears.

The absence of pain in the early stages is not a deviation from the norm, but if the discomfort disappeared abruptly at 8–9 weeks, this is a reason to consult a gynecologist. In the first trimester, there is a high risk of miscarriage and miscarriage. This is due to hormonal disruptions, stress, pathologies in the fetus or diseases of the endocrine system in the mother.

If the level of progesterone, estrogen or thyroid hormones decreases in the body, the mammary glands decrease in size, lose firmness and elasticity, and stop hurting. Although in some cases, discomfort only intensifies. Too intense and sharp pain is also a reason to consult a doctor and take additional tests.

How do breasts hurt during pregnancy?

Discomfort is moderate, medium and strong. With severe pain, the mobility of the upper limbs and chest is limited, so a woman may need to consult a gynecologist and drugs that can reduce symptoms.

Discomfort sensations are different not only in intensity, but also in character. Pregnant women experience:

  • burning and pressing feeling in the nipples;
  • tingling inside the mammary glands;
  • swelling of the nipples and areolas;
  • bursting pain that spreads to both glands;
  • swelling of the nipples and areolas;
  • itching inside the breast or around the nipples;
  • dull or sharp pain that radiates to the armpits, back, and arms.

Discomfort during pregnancy is similar to the symptoms of PMS, but sometimes they are more pronounced or, conversely, less intense than usual. All these are variants of the norm, if there are no other warning signs.

When chest pain is normal

Pain in the mammary glands can periodically come and go throughout pregnancy. And that's okay. A woman should not worry if:

  • stretch marks appear on the chest;
  • a clear or white liquid is released from the nipples in the second or third trimester;
  • areolas darken;
  • itching and dry skin appears;
  • colostrum becomes thicker or thinner.

All of the above symptoms are just variations of the norm. If the pregnant woman does not have an increased or decreased level of hormones, there is no feeling of heat in the mammary glands, there are no seals or strange secretions, and the fetal heartbeat is clearly audible on ultrasound, there is no reason to panic.

When chest pain is a cause for concern

Additional consultation with a gynecologist and mammologist may be needed if a pregnant woman:

  • discharge appears from only one mammary gland;
  • the secret acquires a yellow or light green hue and an unpleasant odor;
  • one breast increases in size, and the second does not;
  • bloody inclusions appear in the discharge for more than 4-5 days;
  • fever and general malaise;
  • the structure of the breast is heterogeneous, there are seals and depressions inside the mammary glands.

Severe pain that does not decrease or disappear for several months can also warn of health problems. In 95% of pregnant women, unpleasant symptoms appear due to infections, inflammatory diseases and benign formations. But in some women, hormonal surges trigger the growth of malignant tumors, so if you have the slightest doubt, you should immediately go to the gynecologist.

The attending physician will examine the chest and help find the cause of strange symptoms. If the gynecologist has suspicions, he will refer the pregnant woman to a mammologist and offer to undergo an additional examination:

  • take a general blood test;
  • do an analysis of fluid from the mammary gland;
  • undergo a breast ultrasound;
  • make an appointment for an MRI or x-ray examination with a contrast agent.

Procedures involving irradiation of a pregnant woman are prescribed only as a last resort, but you should not refuse them. MRI and x-rays will harm the child much less than a neglected malignant tumor in the mother.

How to relieve chest pain during pregnancy

There are several ways to reduce soreness of the mammary glands during pregnancy: diet, physical activity, and the right underwear.

Nutrition for chest pain

Leafy greens, legumes, and nuts reduce nipple sensitivity. And flaxseeds and fresh ginger improve blood circulation in the mammary glands and soothe pain. The ground seeds can be consumed with water, yogurt or fruit juices. Add ginger to salads and soups in small quantities.

Lemon and fennel are useful for pregnant women. Citrus tones the blood vessels and helps with the venous network, and also reduces toxicosis in the first trimester. Warm water with lemon juice can be drunk in the morning to relieve nausea and relieve breast tenderness.

With swelling of the mammary glands, it is worth reducing the amount of salt in the diet. It retains excess fluid in the soft tissues and increases discomfort. Pure water, on the contrary, reduces swelling and improves the well-being of a pregnant woman.

Physical activity

You should not give up sports even at a later date, if there are no contraindications. Moderate physical activity tones up blood vessels and normalizes blood circulation in the mammary glands. Nordic walking and outdoor walks, morning warm-up and special exercises for training the pectoral muscles are useful for pregnant women. You can sign up for fitness or swimming for expectant mothers.

Proper underwear

Ordinary bras with underwire and decorative elements should be replaced with special seamless tops. Underwear for pregnant women is sewn from natural and very soft fabrics so that they do not irritate the skin and do not rub the nipples.

Maternity bras have wide straps that support swollen breasts, and instead of bones, wide and elastic bands. They fix the mammary glands well, but do not disturb blood circulation and outflow of lymphatic fluid.

Bras come in several types:

  • for everyday life;
  • for Sport;
  • for sleep.

Sports tops are tougher. They protect the mammary glands from excessive friction and reduce discomfort. A sleep bra should be softer and more breathable. In the later stages, it is worth buying underwear with internal pockets for disposable liners that absorb colostrum.

The right bra should match the size of your breasts. Tight underwear that compresses the mammary glands too much will only increase discomfort and swelling.

Water procedures

A warm shower helps relieve pain. Hot water dilates blood vessels and improves blood circulation in the mammary glands. A warm shower can be replaced with a sea salt bath, but the procedure should be discussed with a gynecologist.

If hot water only aggravates unpleasant symptoms, you can try cold compresses. Ice wrapped in cloth is applied to the mammary glands for 10-30 minutes 2-3 times a day. Cold constricts blood vessels and milk ducts, reduces swelling and reduces the sensitivity of nerve endings. Ice compresses should be used very carefully so that they do not provoke mastitis.

Proper care will help fight nipple sensitivity. The chest should be washed only with soft gels or baby soap, wiped with a terry towel, and after bathing, rub a nourishing cream into the skin. Moisturizers protect against dryness and cracking, reduce the risk of stretch marks.

Nourishing cream can be supplemented with blue clay masks. It relieves swelling, dryness, inflammation and has a slight anesthetic effect. Clay masks are applied in a thick layer on the mammary glands for 15–25 minutes and washed off with warm water. The procedure is repeated 1-2 times a week. Blue clay can be taken orally and added to the bath while bathing, but these methods are best discussed with a gynecologist.

Breast pain during pregnancy, as well as its absence, is quite natural, but this does not mean that it should be tolerated. It is better to discuss this problem with a gynecologist and, together with a doctor, choose methods that will reduce unpleasant symptoms, improve mood and improve the health of the expectant mother.

Each trimester of pregnancy is an important stage in the formation of a baby in the womb, associated with some discomfort in terms of restructuring the female body. If a woman has chest pain during pregnancy, then first of all it is necessary to identify the cause of this.

Already from the first conception in the breast area, a woman experiences some discomfort that occurs against the background of hormonal modification. It is also worth noting those representatives of the fair sex who suffer from mastopathy; at this time, chest pains will not cause any innovation in them, since they experience such sensations all the time before menstruation.

Often, such pains alarm both pregnant women and doctors because of oncological diseases, namely breast cancer. The fact is that pain in this area is not always the cause of changes in organs. Therefore, it is best to undergo additional examinations when such symptoms appear, which will help to find out the real "fire point".

The main causes of chest pain during pregnancy are the following diseases: myositis of the pectoral muscles, pathology of the respiratory organs, angina pectoris, tonsillocardial syndrome, intercostal neuralgia.

With angina pectoris, chest pain occurs precisely during pregnancy, especially behind the sternum and radiates to the left mammary gland. During a routine examination, it is almost impossible to identify this disease, since both breasts have the same enlarged size and there are no nodes, as such. Therefore, in this case, it is necessary to produce only an electrocardiogram for the correct diagnosis.

With intercostal neuralgia, there are sharp pains in the chest, which are given to the back. If earlier osteochondrosis was diagnosed in people of mature age, then in our time even schoolchildren are subject to such diseases.

When chronic tonsillitis aggravates, pain in the chest also occurs, which mimics coronary heart disease.

Colds also in some cases affect the muscles of the chest with inflammation, which in turn are located precisely behind the mammary glands. As a result, during pregnancy, a woman has chest pains, and when coughing, these symptoms are aggravated.

With inflammation of the respiratory organs, each inhalation and exhalation is inextricably linked with pain in the chest.

If the pregnancy proceeds normally, without pathologies and abnormalities, the mammary glands are modified due to the fact that soon you will have to feed the baby. Due to the increased amount of hormones, the breast increases, which is accompanied by sensations of itching, burning, fullness, and so on. This is the so-called relaxin, which acts on the ligaments of the chest. When the breast comes into contact with the bra, these feelings are exacerbated, and colostrum appears.

Such changes in the body of a woman are observed in primiparas, and they are caused precisely at the genetic level. For each woman, such interpretations in the body are purely individual: for some, these are pains in the chest area, for others, skin stretch marks.

During repeated pregnancy, pain in the chest is practically not observed, and only the release of colostrum appears. The fact is that the mammary glands have already changed their shape, so each subsequent time their increase is not accompanied by pain.

Changes in the chest end at the moment when the placenta is formed, and this happens at the sixteenth to eighteenth week. Sometimes this happens even earlier, it all depends on the characteristics of the woman's body, its individuality.

If during pregnancy you engage in special gymnastics, the effect of which is directed to the pectoral muscles, then you can get rid of pain as a result of improved cell metabolism. It is worth noting that pregnant women are not given medical treatment for pain in the chest.

Also during pregnancy, almost all women experience heartburn. The fact is that the enlarged uterus presses on the stomach, while its displacement upwards. Plus, due to the action of the hormone progesterone, the tissues of the esophagus and stomach relax, and this leads to the penetration of the acidic contents of the stomach into the esophagus. As a result of such changes, a pregnant woman experiences chest pains. To avoid heartburn, it is not recommended to eat two hours before bedtime, and also not to eat fried and fatty foods. Also, doctors advise sleeping on high pillows to make it easier for the stomach to cope with the digestion of food.

The most terrible cause of chest pain during pregnancy can be a malignant process - breast cancer. It mainly occurs in adult women, over the age of forty-five, such cases are associated with late conception of a child. It is also worth noting women who are primiparous, but who have already terminated the pregnancy by force. In such cases, it is worth carefully examining the breast, because with oncology only one mammary gland develops.

If a woman was diagnosed with a precancerous condition before pregnancy, then when carrying a child, it is imperative to be observed not only by a gynecologist, but also by an oncologist. When the symptoms of the onset of the disease are detected in the early stages, then surgical treatment of cancer without chemotherapy is possible.

The absence of chest pain during pregnancy should also alert the expectant mother, in such a situation it is necessary to undergo an ultrasound examination, because this situation can lead to miscarriage.

In any case, if the chest hurts during pregnancy, you should seek the advice of a specialist. In no case should you make a diagnosis yourself and try to get rid of the symptoms. At this time, a woman should think about the health of the baby and do everything as prescribed by the doctor.

If you experience discomfort in the chest area while waiting for the baby, then you should not put off a visit to the hospital.

Only your doctor will be able to find the real cause of the pain and prescribe the necessary treatment. We can only assume what caused it.

The main cause of pain in the left half of the chest in ordinary life are organic diseases of the heart and heart vessels, which occur due to a mismatch between the supply and demand of the heart muscle for oxygen, caused by narrowing of the lumen of the coronary vessels during their spasm or the development of atherosclerosis.

During pregnancy, pain in the heart, even in healthy women, can cause early and late toxicosis, hormonal imbalance, which leads to unstable blood pressure. It is important to consider that in the second half of pregnancy, the heart mechanically begins to move upward and thereby cause pain. Due to the mother's increasing need for oxygen, the load on the diaphragm and intercostal muscles involved in the respiratory process increases significantly. At the same time, the growing fetus interferes with the normal functioning of the respiratory muscles. All this leads to the fact that the tension in the diaphragm and intercostal muscles during breathing leads to fatigue and an increase in the content of under-oxidized metabolic products in them. In turn, these phenomena cause pain in the region of the heart, in the chest, in the ribs and intercostal spaces.

If the pain in the heart does not go away for a long time, you should contact your therapist with your complaints and conduct an appropriate examination. If the cardiogram showed no violations, then in order for the heart to hurt less, the pregnant woman needs to rest more and worry less. If you experience paroxysmal pain in the left half of the chest, you must immediately stop any physical work and walking. You need to sit down in a comfortable position, or lie down, and then relax well.

In order not to provoke chest pain during pregnancy, you need to eat well and walk more often in the fresh air. In addition, it is necessary to attend a antenatal clinic in a disciplined manner so that doctors can identify the disease in a timely manner and take action.