Differential Diagnosis for 13 y.o. Female with Chest Pressure and Shortness of Breath when Lying Down
- Single most likely diagnosis:
- Mitral Valve Prolapse: This condition is common in adolescents and can cause chest discomfort or pressure, especially when lying down due to increased venous return and subsequent mitral valve prolapse. Symptoms often improve when upright.
- Other Likely diagnoses:
- Anxiety or Panic Disorder: These conditions can cause chest pressure and shortness of breath, which may worsen when lying down due to increased awareness of bodily sensations.
- Gastroesophageal Reflux Disease (GERD): Lying down can exacerbate GERD symptoms, leading to chest pressure and shortness of breath due to stomach acid irritating the esophagus and potentially triggering bronchospasm.
- Asthma: Although symptoms typically worsen with exertion or exposure to triggers, some individuals may experience worsening asthma symptoms when lying down, possibly due to increased airway resistance in the supine position.
- Do Not Miss diagnoses:
- Pulmonary Embolism: Although rare in adolescents, a pulmonary embolism can cause sudden onset of shortness of breath and chest pressure, which may worsen when lying down. It is crucial to consider this diagnosis due to its high mortality rate if left untreated.
- Cardiac Tamponade: This life-threatening condition, characterized by fluid accumulation in the pericardial sac, can cause chest pressure and shortness of breath that worsens when lying down. Prompt recognition and treatment are essential.
- Pneumothorax: A spontaneous pneumothorax can occur in healthy adolescents, leading to sudden chest pressure and shortness of breath. Symptoms may worsen when lying down due to increased pressure on the lungs.
- Rare diagnoses:
- Pectus Excavatum or other chest wall deformities: These conditions can cause chest pressure and shortness of breath, especially when lying down, due to the abnormal shape of the chest wall affecting lung expansion.
- Diaphragmatic paralysis or eventration: These rare conditions can lead to breathing difficulties and chest pressure, which may worsen when lying down due to the diaphragm's inability to function properly.