Preeclamptic angina--a pathognomonic symptom of preeclampsia

Abstract

Aim: To describe an important symptom of preeclampsia previously not defined.

Methods: Individual clinician experience case series collected and recorded prospectively.

Results: Little attention has been given to symptoms in the diagnosis of preeclampsia. Although "epigastric pain" is often mentioned, there is no accurate description in the literature of the specific diagnostic attributes that distinguish the upper abdominal pain of preeclampsia from that of other causes. The symptom is described herein and defined as "preeclamptic angina" (PEA). It is associated strongly with severe preeclampsia but often not recognized, particularly when it is not accompanied by usual features of preeclampsia. It is experienced typically as a severe pain that begins at night, usually maximal in the low retrosternum or epigastrium, constant and unremitting for 1-6 h. It may radiate or be confined to the right hypochondrium or back. The liver is tender on palpation. The pain may precede the diagnosis of preeclampsia by 7 days or more and may be the only abnormality on presentation such that preeclampsia is not suspected. It is of ominous prognosis and is associated with a high rate of maternal and fetal complications. Laboratory and clinical abnormalities of preeclampsia are ultimately manifest in all cases, but their absence at the time of presentation may lead to erroneous alternative diagnoses. Recognition of this characteristic symptom will lead to earlier diagnosis of preeclampsia in atypical cases, with the potential to avoid maternal and perinatal morbidity and mortality.