ABSTRACT
Non-cardiac causes of chest pain are broadly the same in pregnancy as in the non-pregnant state. The most common causes will be non-specific, and often no definite aetiology will be found. Diagnoses such as ‘intercostal myalgia’, ‘muscular strain’, and ‘costochondritis’ are invariably made on clinical grounds alone after excluding other more serious conditions. There is no laboratory or radiological tests that will confirm these conditions and the diagnosis must therefore be based on history and examination together with a normal chest X-ray in particular. Oesophageal reflux is extremely common in pregnancy and can result in chest pain, usually manifesting as ‘heartburn’, a burning sensation in the centre of the chest worse after meals. Up to two-thirds of pregnant women may have reflux, caused by relaxation of the gastro-oesophageal sphincter owing to high progesterone levels. Peptic ulcer disease is less common in pregnant women, but the resultant upper abdominal pain may manifest as lower chest pain instead.
