Differential Diagnosis for 3rd Trimester Pregnancy Nocturnal Dyspnea, Chest Tightness, and Tachycardia
- Single Most Likely Diagnosis
- Pregnancy-Induced Hypertension or Preeclampsia: This condition is a leading cause of maternal and fetal morbidity and mortality in the third trimester. Nocturnal dyspnea, chest tightness, and tachycardia can be symptoms of severe preeclampsia, which may lead to pulmonary edema.
- Other Likely Diagnoses
- Gestational Pulmonary Embolism: Pregnancy increases the risk of venous thromboembolism due to hypercoagulability, venous stasis, and vascular wall injury. Symptoms can include sudden onset of dyspnea, chest pain, and tachycardia.
- Asthma or Chronic Obstructive Pulmonary Disease (COPD) Exacerbation: Pre-existing respiratory conditions can worsen during pregnancy due to increased demand on the respiratory system. Nocturnal symptoms can be particularly bothersome.
- Anxiety or Panic Disorder: Hormonal changes and the stress of pregnancy can exacerbate or trigger anxiety and panic disorders, leading to symptoms like dyspnea, chest tightness, and tachycardia.
- Do Not Miss Diagnoses
- Pulmonary Embolism: Although included in other likely diagnoses, it's crucial to emphasize that missing a pulmonary embolism can be fatal. It requires immediate attention and anticoagulation.
- Cardiomyopathy (Peripartum Cardiomyopathy): This rare but potentially life-threatening condition can present with symptoms of heart failure, including nocturnal dyspnea, and requires prompt diagnosis and treatment.
- Aortic Dissection: Although rare, aortic dissection is a catastrophic condition that can present with chest pain and dyspnea. Pregnancy, especially in women with pre-existing conditions like Marfan syndrome, increases the risk.
- Rare Diagnoses
- Amniotic Fluid Embolism: A rare but often fatal condition where amniotic fluid enters the maternal circulation, triggering a severe reaction. Symptoms can include sudden onset of dyspnea, hypotension, and cardiac arrest.
- Pulmonary Arterial Hypertension: A condition characterized by high blood pressure in the arteries of the lungs, which can lead to right heart failure. Symptoms include dyspnea, fatigue, and in severe cases, chest pain and syncope.