Education And Debate

Lesson of the Week: The risks of delay in diagnosis of breathlessness in pregnancy

BMJ 1995; 311 doi: (Published 21 October 1995) Cite this as: BMJ 1995;311:1083
  1. C A Morley, consultanta,
  2. B A Lim, senior house officera
  1. aDepartment of Cardiology, St Luke's Hospital, Bradford BD5 0NA
  1. Correspondence to: Dr Morley.
  • Accepted 31 January 1995

Heart disease is an important cause of dyspnoea in pregnancy. The diagnosis can easily be missed by the unwary unless it is specifically looked for. Owing to the physiological change and hyperdynamic circulation of pregnancy, patients often deteriorate suddenly and unexpectedly, catching both them and their doctors by surprise. If the diagnosis is not made early this may prove fatal. We describe five cases (over two years) of cardiac disease presenting for the first time during pregnancy.

Be aware of cardiac dyspnoea in pregnant women when they are breathless

Case reports


A 33 year old Asian (Indian subcontinent) woman presented in the 16th week of pregnancy (para 3+0). Since her arrival from Pakistan five years previously she had been complaining of shortness of breath with poor exercise tolerance, and had a copious productive cough with clear sputum. She was treated by her general practitioner with antihistamines for “allergy.” She was admitted acutely to the obstetrics unit as she was thought to be draining liquor. The medical team was then asked to see her in view of dyspnoea at rest. A few days before her acute admission she had also been complaining of a worsening cough with greenish sputum.

On examination she was dyspnoeic at rest, feverish, in sinus tachycardia, and had widespread rhonchi and right basal crepitations. No heart murmurs were heard. A chest x ray was not requested until the next day as it was thought that this was a case of infective exacerbations of previously undiagnosed asthma. There was also some reluctance to perform a chest x ray as she was pregnant. She improved initially with oxygen, nebulisers, and antibiotics, but several hours later she suddenly became very dyspnoeic and started coughing copious amounts of sputum.

She suffered respiratory arrest, was intubated successfully, resuscitated, and transferred to the intensive care …

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