Differential Diagnosis for 30-year-old Female with Intermittent Chest Pain and Bilateral Breast Burning Sensation

• Single most likely diagnosis:
  • Costochondritis: This condition, also known as Tietze's syndrome, is characterized by inflammation of the cartilage that connects the ribs to the breastbone, leading to chest pain and tenderness. The patient's symptoms of intermittent chest pain and bilateral breast burning sensation, along with her daily gym workouts, make this diagnosis plausible as costochondritis can be exacerbated by physical activity.
• Other Likely diagnoses:
  • Precordial Catch Syndrome: A condition that causes sharp, stabbing chest pain, often related to the muscles and bones in the chest wall. It can be triggered by deep breathing, movement, or even anxiety, which might align with the patient's workout routine.
  • Gastroesophageal Reflux Disease (GERD): Although more commonly associated with heartburn and regurgitation, GERD can sometimes present with chest pain. The patient's consumption of pre-workout and creatine daily might influence her symptoms, especially if these substances affect her gastrointestinal system.
  • Breast Conditions (e.g., Mastitis, Fibrocystic Changes): Given the bilateral breast burning sensation and the ordered ultrasound, it's essential to consider breast-related conditions. Mastitis or fibrocystic breast changes could explain her symptoms, especially if there's an underlying infection or hormonal influence.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.):
  • Acute Coronary Syndrome (ACS): Although less common in young females, ACS, including myocardial infarction, must be considered due to the potential for fatal outcomes. Risk factors such as family history, smoking, or other cardiovascular risk factors would increase the likelihood.
  • Pulmonary Embolism (PE): Sudden onset of chest pain, especially if accompanied by shortness of breath, could indicate a PE. This condition is life-threatening and requires immediate attention.
  • Aortic Dissection: A severe, life-threatening condition where there is a tear in the aorta's inner layer. Chest pain is often severe and tearing in nature, but any chest pain in a young individual with risk factors (e.g., hypertension, certain genetic conditions) warrants consideration of this diagnosis.
• Rare diagnoses:
  • Spontaneous Coronary Artery Dissection (SCAD): A rare condition where there is a tear in the coronary artery, which can lead to a heart attack. It's more common in women and can be associated with fibromuscular dysplasia or other conditions.
  • Hypertrophic Cardiomyopathy: A condition where the heart muscle becomes thickened, which can lead to obstruction of blood flow and increase the risk of sudden cardiac death. It's a rare cause of chest pain but is critical to diagnose due to its implications for exercise and potential sudden death.