Approach to dyspnea, palpitations, and headaches in pregnancy

Pregnant individuals commonly experience symptoms such as dyspnea, palpitations, and headache. While often benign and physiologic, these symptoms can also signal serious conditions that require urgent investigation and treatment. General Internists are increasingly called upon to assess such concerns in both outpatient and acute care settings. This review offers a symptom-based, practical approach to evaluating these presentations during pregnancy, with emphasis on balancing maternal and fetal safety. Dyspnea is frequently reported and usually reflects normal respiratory and cardiovascular adaptations. However, clinicians must be vigilant for life-threatening causes such as pulmonary embolism, peripartum cardiomyopathy, or preeclampsia-associated pulmonary edema. Palpitations are common due to increased heart rate and cardiac output, but may reflect arrhythmias that require prompt assessment and, in some cases, pharmacologic therapy. Headaches may be due to primary headache disorders like migraine, but new or worsening headache in pregnancy warrants careful evaluation for preeclampsia, stroke, or cerebral venous thrombosis. Throughout this review, we highlight key physiological adaptations in pregnancy, discuss relevant differential diagnoses, and provide practical guidance on investigations and treatment options that balance maternal and fetal safety. This article aims to equip internists with the tools to recognize when symptoms require further workup and to ensure pregnant individuals receive timely, evidence-informed care.