What is the diagnosis for a 17-year-old male patient presenting with pleuritic chest pain, a history of asthma, and recent symptoms of chest tightness, tachycardia, and shortness of breath, who was previously diagnosed with a common cold at an urgent care visit?

From the Guidelines

The patient's symptoms of chest tightness, racing heart, and shortness of breath are likely related to an anxiety episode, exacerbated by his recent respiratory infection and underlying asthma, rather than a serious pulmonary or cardiac condition. The patient's history of asthma and recent diagnosis of a common cold at an urgent care visit the previous day, along with his symptoms of congestion and cough for three days prior to this ED visit, suggest that his asthma may be contributing to his current symptoms 1. The chest X-ray findings of hypoexpanded but clear lungs with some vascular crowding, and the negative urine drug screen, support the idea that the patient's symptoms are not due to a serious pulmonary or cardiac condition 1. Key indicators of a diagnosis of asthma, such as wheezing, a history of recurrent cough, wheezing, difficulty in breathing, or chest tightness, and symptoms that occur or worsen in the presence of specific triggers, are present in this patient 1. The patient's documented history of anxiety episodes, which likely contributed to his current symptoms, and the combination of his recent respiratory infection and underlying asthma, may have exacerbated his anxiety symptoms, leading to the sensation of chest tightness and tachycardia. Some important factors to consider in the patient's medical history include the overall pattern of symptoms, precipitating factors, and a family history of asthma, allergy, or other atopic disorders 1. The patient's symptoms and history suggest that his condition can be managed with close monitoring and treatment of his asthma and anxiety, rather than requiring immediate intervention for a serious pulmonary or cardiac condition. The fact that this represents his fourth or more ED visit within a 12-month period highlights the need for close follow-up and management of his asthma and anxiety to prevent future episodes and reduce morbidity, mortality, and improve quality of life.

From the Research

History of Present Illness (HPI)

• The patient, a 17-year-old male, presented to the ED with complaints of chest tightness, heart racing, and anxiety-like episodes with shortness of breath 2, 3, 4, 5.
• The patient's mother reported that he was seen at an urgent care the previous day and diagnosed with a common cold, and that he has a history of asthma 6.
• The patient's symptoms started when he woke up in the morning, and he denied any current cough, fever, or chills.
• The patient admitted to having anxiety episodes and was feeling comfortable at the time of presentation, with no reported chest pain.

Clinical Findings

• A chest x-ray was performed, which showed shallow breath with vascular crowding, but was otherwise clear 2, 3, 4, 5.
• The lungs were hypoexpanded and clear, with the trachea midline and upper limits of normal pulmonary vasculature.
• No pneumothorax or significant pleural effusion was found, and the regional osseous structures were intact.
• A urine drug screen was negative, and the patient's BUN was slightly elevated.

Differential Diagnosis

• Pleuritic chest pain, which can be caused by a variety of conditions, including pulmonary embolism, pneumonia, pneumothorax, and pericarditis 2, 3, 4, 5.
• The patient's history of asthma and recent diagnosis of a common cold may also be relevant to his presentation 6.
• The patient's symptoms and clinical findings will need to be further evaluated to determine the underlying cause of his pleuritic chest pain.