Differential Diagnosis for 27 y/o Patient with Sleep Disturbances and Chest Pain

• Single Most Likely Diagnosis
  • Insomnia related to stress and anxiety: The patient's decreased ability to sleep is directly attributed to increased stressful family situations, which is a common cause of insomnia. The absence of suicidal ideation (SI) or homicidal ideation (HI), substance use, and other alarming symptoms supports this diagnosis.
• Other Likely Diagnoses
  • Anxiety Disorder: Given the patient's stressful family situations and sleep disturbances, an anxiety disorder is a plausible diagnosis. Anxiety can manifest as chest pain, especially if it radiates to the back and is exacerbated by movement.
  • Depression: Although the patient denies SI/HI, depression can still be a contributing factor to sleep disturbances and chest pain. Further evaluation is necessary to rule out depressive symptoms.
  • Musculoskeletal Pain: The patient's chest pain radiating to the back, exacerbated by movement, could be related to musculoskeletal issues, such as costochondritis or muscle strain.
• Do Not Miss Diagnoses
  • Acute Coronary Syndrome (ACS): Although the patient is young, it is essential to consider ACS, especially if the chest pain is severe (7/10) and radiates to the back. ACS can be deadly if missed, and further evaluation, such as an ECG and troponin levels, is necessary.
  • Pulmonary Embolism (PE): PE is a life-threatening condition that can present with chest pain and shortness of breath. Although the patient does not report shortness of breath, it is crucial to consider PE, especially if the patient has a history of deep vein thrombosis or other risk factors.
• Rare Diagnoses
  • Mitral Valve Prolapse: This condition can cause chest pain, especially if it is related to mitral regurgitation. However, it is less likely given the patient's age and lack of other symptoms.
  • Hypothyroidism: Hypothyroidism can cause musculoskeletal pain, sleep disturbances, and fatigue. Although it is a rare diagnosis, it is essential to consider it, especially if the patient has other symptoms such as weight gain or cold intolerance.