Differential Diagnosis for a 50 year-old female patient with cough and vomiting only with running

• Single most likely diagnosis:
  • Exercise-induced gastroesophageal reflux disease (GERD): This condition is likely due to the increased intra-abdominal pressure during running, which causes stomach acid to flow back into the esophagus, triggering cough and vomiting.
• Other Likely diagnoses:
  • Exercise-induced asthma: Although the patient has no known lung disease, exercise can trigger asthma symptoms in some individuals, leading to cough and potentially vomiting.
  • Dehydration or heat exhaustion: Running can cause dehydration and heat exhaustion, which may lead to vomiting, and in some cases, a dry cough.
  • Vasovagal syncope or reflex: The physical exertion of running may trigger a vasovagal response, leading to nausea, vomiting, and potentially a cough.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.):
  • Pulmonary embolism: Although the patient has no known cardiac or lung disease, a pulmonary embolism can occur without prior history and may present with cough and vomiting during exertion.
  • Myocardial infarction: It is essential to consider cardiac causes, even in patients without known cardiac disease, as myocardial infarction can present atypically, especially in women.
  • Aortic dissection: This is a rare but life-threatening condition that may cause cough and vomiting during exertion due to the intense physical stress.
• Rare diagnoses:
  • Pneumomediastinum: A rare condition where air leaks into the mediastinum, potentially causing cough and vomiting during intense physical activity like running.
  • Esophageal rupture or tear: Although rare, an esophageal rupture or tear can occur during intense vomiting or coughing, leading to severe consequences if not promptly treated.