Evaluation of cardiovascular symptoms

Abstract

Objective: To determine whether cardiac symptoms during pregnancy are predictive of pathology. Methods: The records of 50 gravidas with symptoms of shortness of breath, palpitations, chest pain, or syncope, and who received ECG, echocardiography, Holter monitor, and/or cardiology consultation were reviewed. Independent variables analyzed were gestational age (EGA) at symptom presentation and resolution, type of symptom, and the presence of a positive medical history. Data were tested for normality. Student t, X 2, and Fisher exact tests were used for analysis (significance: P < 0.05). Data are reported as mean ± SD or median (interquartile range). Results: Thirty-one patients (62%) had a negative workup, and 19 (38%) had a positive workup. There was no significant difference in maternal age (24.8 + 4.9 versus 24.4 + 7.0 years), parity (1.0 [0–1] versus 1.5[1–2]), EGA at symptom presentation (22.8 + 9.3 versus 22.4 + 8.3 weeks), or resolution (28.9 + 8.4 versus 26.22 + 7.7 weeks) between those without and with pathology. There was no significant association between number of symptoms and the odds of a positive test result (odds ratio 1.22, 95% CI 0.31–4.79). Any positive cardiac medical history was significantly associated with the probability of a positive cardiovascular test result (odds ratio 6.23, 95% CI 1.52–26.68, P= 0.008). Symptoms plus a positive medical history did not significantly improve the odds for detecting a positive cardiovascular test result (odds ratio 3.03, 95% CI 0.67–14.26). Conclusion: Cardiac symptoms commonly occur in pregnancy. A prior medical history positive for any cardiovascular abnormality may be more predictive of actual pathology than symptoms alone.