Differential Diagnosis for a 26-year-old Pregnant Female with Shortness of Breath
Single Most Likely Diagnosis
- Pulmonary Embolism (PE): Given the patient's history of DVT and current pregnancy, which increases the risk of thromboembolic events, PE is a highly plausible cause of her shortness of breath. The lack of relief with her inhaler also points away from asthma or other obstructive lung diseases, making PE a prime consideration.
Other Likely Diagnoses
- Asthma Exacerbation: Although the patient tried her inhaler with no relief, asthma cannot be immediately ruled out, especially if the exacerbation is severe. Pregnancy can also affect asthma control.
- Pregnancy-related Cardiomyopathy or Heart Failure: Pregnancy can lead to or exacerbate heart failure, and shortness of breath is a common symptom. The patient's history of SVT might also suggest underlying cardiac issues.
- Anxiety or Panic Attack: Pregnancy can be a time of significant anxiety, and panic attacks can present with shortness of breath. However, the patient's medical history and the severity of her symptoms might make this less likely.
Do Not Miss Diagnoses
- Pulmonary Embolism (already mentioned but critical to reiterate): Due to its high mortality rate if untreated, PE must be considered and ruled out promptly.
- Eclampsia or Preeclampsia with Pulmonary Edema: Although less common, these conditions can present with shortness of breath and are critical to diagnose due to their potential for severe maternal and fetal complications.
- Cardiac Tamponade or Other Cardiac Emergencies: Given the patient's history of SVT, other cardiac emergencies, though rare, must be considered, especially if there's a significant change in clinical status.
Rare Diagnoses
- Amniotic Fluid Embolism (AFE): A rare but potentially catastrophic condition that can occur during pregnancy, AFE presents with sudden onset of shortness of breath, hypotension, and potentially cardiac arrest.
- Pregnancy-related Thrombotic Thrombocytopenic Purpura (TTP): Although very rare, TTP can present with a variety of symptoms including shortness of breath due to the potential for thrombi formation in the lungs.
- Lymphangioleiomyomatosis (LAM): A rare lung disease that can cause shortness of breath, more commonly diagnosed in women of childbearing age, but its presentation during pregnancy would be unusual.