Differential Diagnosis
The patient presents with two main concerns: abnormal uterine bleeding (AUB) and occasional chest pain. The following differential diagnoses are organized into categories:
Single Most Likely Diagnosis
- Abnormal Uterine Bleeding (AUB) due to hormonal imbalance: The patient's history of prolonged and heavy menstrual bleeding, resulting in anemia, suggests a hormonal imbalance as the most likely cause of her AUB.
- Gastroesophageal Reflux Disease (GERD): The patient's symptoms of chest pain radiating from the abdomen, burping, and anxiety, especially when considering her history of GI upset, point towards GERD as a likely cause of her chest pain.
Other Likely Diagnoses
- Uterine Fibroids: The patient's history of AUB and anemia could be related to uterine fibroids, which are common in women of reproductive age.
- Dysmenorrhea: The patient's menstrual cramps and heavy bleeding could be related to dysmenorrhea, a common condition in women.
- Peptic Ulcer Disease: The patient's symptoms of chest pain and GI upset could be related to peptic ulcer disease, especially considering her history of smoking.
- Musculoskeletal Chest Pain: The patient's report of chest pain related to posture and her plan to undergo a correction procedure suggests that musculoskeletal chest pain could be a contributing factor.
Do Not Miss Diagnoses
- Coronary Artery Disease: Although the patient denies crushing chest pain and diaphoresis, coronary artery disease must be considered, especially given her history of smoking and multiple ER visits.
- Pulmonary Embolism: The patient's history of chest pain and anxiety warrants consideration of pulmonary embolism, although her symptoms do not strongly suggest this diagnosis.
- Ectopic Pregnancy: Although the patient is on Depo-Provera, ectopic pregnancy must be considered in any woman of reproductive age presenting with abdominal pain and bleeding.
Rare Diagnoses
- Endometrial Hyperplasia or Cancer: Although less likely, endometrial hyperplasia or cancer could be a cause of the patient's AUB, especially if she has risk factors such as obesity or a family history.
- Esophageal Spasm or Achalasia: The patient's symptoms of chest pain and burping could be related to esophageal spasm or achalasia, although these conditions are less common.
- Cardiac Causes of Chest Pain (e.g., Pericarditis, Cardiomyopathy): Although less likely, other cardiac causes of chest pain must be considered, especially given the patient's history of chest pain and multiple ER visits.