Differential Diagnosis for 38 F with Abdominal Pain and Associated Symptoms

The patient's symptoms of crushing generalized abdominal pain, pressure in the back, nausea, lightheadedness, and numbness/tingling in the right arm, especially with a history of similar symptoms post-intercourse, suggest a range of possible diagnoses. Here's a categorized differential diagnosis:

• Single Most Likely Diagnosis

  • Acute Coronary Syndrome (ACS): The patient's symptoms of crushing abdominal pain radiating to the back, nausea, lightheadedness, and numbness/tingling in an arm, triggered by exertion (exercise) and possibly by emotional/physical stress (intercourse), could be indicative of ACS, particularly given the atypical presentation which can occur in women.

• Other Likely Diagnoses

  • Gastroesophageal Reflux Disease (GERD): Atypical chest pain or abdominal pain can be a manifestation of GERD, especially if exacerbated by exertion or certain positions.
  • Panic Attack: The symptoms of abdominal pain, nausea, lightheadedness, and numbness/tingling could also be consistent with a panic attack, especially given the triggers (exercise and intercourse) which can be associated with stress or anxiety.
  • Musculoskeletal Pain: The pain could be musculoskeletal in origin, especially if related to the exercise routine, though the presence of systemic symptoms like nausea and lightheadedness makes this less likely.

• Do Not Miss Diagnoses

  • Aortic Dissection: Although less common, the severe, tearing nature of the pain (described as crushing) and its radiation to the back, along with the history of similar symptoms post-intercourse, necessitates consideration of aortic dissection, which is a medical emergency.
  • Pulmonary Embolism (PE): The sudden onset of symptoms like chest or abdominal pain, nausea, and lightheadedness, especially if associated with shortness of breath or tachycardia (not mentioned but important to assess), should prompt consideration of PE.
  • Myocardial Infarction (MI): Similar to ACS, an MI should be considered, especially in women who may present with atypical symptoms.

• Rare Diagnoses

  • Spontaneous Coronary Artery Dissection (SCAD): A rare cause of ACS, more common in women, often without traditional cardiovascular risk factors, and can be precipitated by intense emotional or physical stress.
  • Esophageal Rupture: A rare but serious condition that could present with severe abdominal or chest pain, especially if there was an association with vomiting or other esophageal trauma.
  • Hereditary Angioedema: A rare genetic disorder that can cause episodes of severe abdominal pain due to angioedema of the gastrointestinal tract, though typically accompanied by other symptoms like facial or peripheral edema.