Table 34: Cardiovascular symptoms and signs, and the pregnant state
Findings	Noted in normal pregnancy	Not seen in normal pregnancy
Dizziness, palpitations	Common	Syncope on exertion
Dyspnea	Common (75%) if mild, not progressive	Progressive or New York Heart Association functional class IV
Orthopnea	Common, especially late in term
Decreased exercise capacity	Mild, not progressive	New York Heart Association functional class IV symptoms
Chest pain	Common, may be musculoskeletal in origin, not progressive. Not typically anginal	Typical angina pain, severe or tearing pain may be dissection, especially late in term/peripartum
Pulse	Increased volume, rate	Decreased volume or upstroke
Peripheral edema	Mild, common	Severe or progressive edema
Apical beat	Mildly displaced laterally, hyperdynamic	Double or triple apex beat, thrill
Heart rate	Sinus tachycardia common	Atrial fibrillation, persistent supraventricular tachycardia, symptomatic ventricular arrhythmias
Neck veins	May be mildly distended	Progressively distended with dominant V wave
Heart sounds	Increased S1, S2, S3 common Systolic ejection murmur common; continuous murmur (venous hum, mammary souffle) not common	Opening snap, pericardial rub, S4 Late peaking systolic murmur, diastolic murmur, other continuous murmurs