Differential Diagnosis of Chest Tightness and Tachycardia in Pregnancy

Cardiac Arrhythmias

The American Heart Association recommends considering supraventricular tachycardia as the most common arrhythmic cause in pregnant patients, occurring in 20-44% of pregnancies, often presenting with sudden-onset palpitations, chest tightness, and documented tachycardia 1, 2
The European Society of Cardiology states that pregnancy-related hormonal changes, increased catecholamines, and hemodynamic alterations directly promote arrhythmogenesis, which can cause hemodynamic compromise affecting both maternal and fetal perfusion if sustained 3, 1, 4

The American College of Cardiology recommends excluding peripartum cardiomyopathy, which presents with new-onset heart failure during the last 6 weeks of pregnancy or postpartum, often manifesting with chest tightness, dyspnea, and arrhythmias including ventricular tachycardia 3, 4

The Endocrine Society notes that hyperthyroidism can exacerbate or cause arrhythmias in pregnancy, and thyroid storm can precipitate atrial fibrillation or flutter with associated tachycardia, diaphoresis, and chest discomfort 2, 4

The European Heart Journal states that most palpitations during pregnancy are benign, caused by normal physiologic changes including increased blood volume, cardiac output, and heart rate, which can be exacerbated by anxiety, dehydration, caffeine, or physical exertion 3, 1

The American Heart Association advises against dismissing tachycardia as "normal pregnancy changes" without proper evaluation, as serious arrhythmias and structural disease can present similarly, and delaying cardioversion in hemodynamically unstable patients due to pregnancy concerns can be harmful 1, 2, 4