Differential Diagnosis for a 24-year-old Female with Chest Pain
- Single most likely diagnosis:
- Panic attack: Given her past medical history of panic attacks and the atypical presentation of her symptoms, it's possible that her current episode is a severe panic attack. The symptoms of chest pain, shortness of breath, and a rapid heart rate are consistent with panic attacks, and the fact that she describes the shortness of breath as needing to yawn suggests a possible anxiety-related etiology.
- Other Likely diagnoses:
- Costochondritis: The mid-sternal location of her chest pain and the fact that it radiated to her left arm could be consistent with costochondritis, an inflammatory condition of the cartilage that connects the ribs to the sternum.
- Musculoskeletal strain: The onset of pain after walking up a flight of steps and the mid-sternal location of the pain could suggest a musculoskeletal strain, possibly related to overuse or poor posture.
- Hyperventilation syndrome: Her symptoms of shortness of breath, rapid heart rate, and chest pain could be related to hyperventilation, which can be triggered by anxiety or stress.
- Do Not Miss diagnoses:
- Acute coronary syndrome (ACS): Although she is young and has no past medical history of cardiac disease, her family history of early myocardial infarction (MI) and the presence of risk factors such as oral contraceptive use increase her risk for ACS. It's essential to consider this diagnosis, even if it's unlikely, due to its potential severity and the need for prompt treatment.
- Pulmonary embolism (PE): The combination of chest pain, shortness of breath, and tachycardia could suggest a PE, especially if she has any underlying risk factors such as a blood dyscrasia or recent immobility.
- Aortic dissection: Although rare in young women, aortic dissection can present with sudden, severe chest pain that radiates to the arm, and it's essential to consider this diagnosis due to its high mortality rate if left untreated.
- Rare diagnoses:
- Spontaneous coronary artery dissection (SCAD): This rare condition can cause ACS and is more common in young women, often without traditional risk factors.
- Pericarditis: Inflammation of the pericardium can cause chest pain that may radiate to the arm, and it's essential to consider this diagnosis, especially if she has any underlying conditions that may increase her risk.
- Pneumothorax: Although unlikely, a pneumothorax can cause chest pain and shortness of breath, and it's essential to consider this diagnosis, especially if she has any underlying lung disease or recent trauma.