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Forum Name: Cardiology Symptoms

Question: difficulty swallowing and pulse in suprasternal notch


 tkmillson - Tue Sep 23, 2008 12:11 am

I am a 30 yr old female, currently 34 weeks pregnant. I have a 5 year history of hypertension controlled on meds, and am a smoker. Several months ago, I started having difficulty swallowing, well, the mechanics worked but things (in particular tablets) would get stuck on the way down, it felt like at the level of the suprasternal notch, and generally after some time of extending and turning my neck they would be swallowed. In searching my neck for a lump, I noticed a strong palpable pulse in the notch, and this pulse is also visible. I am a nurse and have a basic understanding of anatomy and do not recall there being an artery in this area. I am concerned that this could possibly be a thoracic aortic aneurysm, compressing my esophagus. I also get on occassion a tightening and pulsing type pain in between my shoulder blades and traveling down my spine, moderately severe but lasting only a few seconds, not associated with any type of activity or movement. In addition, not sure if this is important or not, have frequent palpitations that have been identified as PVC's on telemetry.

So, my question is, are these symptoms likely to be benign or indicative of something more serious, like an aneurysm? As I am pregnant, I am reluctant to seek out imaging studies at this time.
 John Kenyon, CNA - Wed Oct 01, 2008 10:33 pm

User avatar Hello -

Well you certainly have posed an interesting dilemma. While the new pulsing at the base of your neck could be something you just never noticed before or even could be due to your being pregnant (things tend to get pushed up as well as out), there needs to be some certainty that this is not, for some odd reason, a thoracic aneurism, since that would be a major consideration in the delivery process.

Since you have a history of hypertension and you smoke, there is a slightly greater risk of aneurism than if those factors weren't present. And while age usually is a big factor in aortic aneurisms, there is always that genetic wild card. So it seems reasonable to want to rule it out. How to do that safely is the big challenge. Probably the safest way to accomplish this at this stage of your pregnancy would be to attempt an ultrasound of the base of the anterior neck, which might well show up your anatomy there. It's the least noxious type of imaging technique where the baby is concerned, and while it's not ideal, it could clarify things a good deal, depending.

The difficulty swallowing, the pulsing in the back, and the apparently new pulsatile area at the base of your neck could all be by-products of pregnancy, but they also could be symptoms of an ascending aortic aneurism, although your age argues against it. Clearly x-ray, MRI and CT are out of the question unless there is some compelling reason to employ those. If an US was to show up anything suspicious, then it would be more reasonable to consider more sophisticated imaging. Also, a careful listen by a cardiologist with a good ear, directly at the site, could perhaps help steer the investigation of this. While the odds are against it being an aneurism, and while pregnancy could be causing all these symptoms, it is just suspicious enough to warrant a closer look. Those PVCs are of no consequence at all, and they are likely to become more frequent during pregnancy than at other times, but have no intrinsic diagnostic value at all.

I hope this is helpful. Best of luck to you, and please keep us updated.

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