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Pregnant with twins. Having throbbing pulsing pain in upper back and chest. Not able to sleep. Any ideas?

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I am 29 weeks pregnant with twins and am having a throbbing pulsing pain in my upper back which then goes in to my chest. It lasts no longer than a minute but happens quite a few times the last few days and can wake me up. Any ideas ? Many thanks
Posted Thu, 2 Aug 2012 in Pregnancy
Answered by Dr. Anil Grover 3 hours later
Hi there,
Thanks for writing in.
I am a qualified and certified cardiologist and I read your mail with background with diligence.

During pregnancy few things occur:
1. Blood volume increases more so in twins, Periphearal resistance falls
2. The middle layer of aortic wall becomes week (especially in tall woe
3. In your case there is anemia too in addition to hypertension.

These all factors contribute to dilatation of aorta and unfolding. There may be formation of aortic aneurysm of descending thoracic (part of great artery which arising from heart has formed arch and now in thorax on its way down. Throbbing backache is typical symptom.
Best investigation will echocardiography including suprasternal view. THis will give outline of aorta also look for leakage of valve aortic regurgitation. Treatment is to keep after load low. Keep BP around 110-115/70-80 with help of drugs like alpha and b blockers. As she is 29 weeks no. By giving abdominal lead sheath to protect fetus a PA an lateral x-ray or alternatively, Trans-esophageal echo to delineate aorta from aortic valve to diaphragm. If there is serious suspicion of large aneurysm performing fetal viability and delivery ( which will be always be surgical Cesarean section) as labor is not indicated in her ought to be plan of action. Personally, I think for the sake of safety we are erring on the side of abundant precaution. Then no body was wants an aortic dissection. Detailed evaluation by thoracic CT/ MRI has to wait till the birth of twins. I would urge to have talk with your obstetrician who in turn bring cardiologist in pcture after doing detailed physical examination. If you have any more question please ask, I shall reply as soon as possible.
With Best Wishes

Dr Anil Grover,
M.B.;B.S, M.D. (Internal Medicine) D.M.(Cardiology)
http://www/ WWW.WWWW.WW

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