Differential Diagnosis for SOB and Elevated Troponin at 24 Weeks Pregnant

Single Most Likely Diagnosis

• Pulmonary Embolism (PE): This condition is a leading cause of maternal mortality during pregnancy. The combination of shortness of breath (SOB) and elevated troponin levels, especially in a pregnant woman at 24 weeks, raises a high suspicion for PE due to the hypercoagulable state associated with pregnancy.

Other Likely Diagnoses

• Myocardial Infarction (MI): Although less common in younger populations, the physiological changes of pregnancy can increase the risk of coronary artery disease. Elevated troponin is a key indicator of myocardial damage, making MI a plausible diagnosis.
• Peripartum Cardiomyopathy: This condition, characterized by heart failure in the absence of another identifiable cause, can present with symptoms similar to those of heart failure, including SOB. While it typically occurs in the last month of pregnancy or shortly after delivery, it could be considered in a pregnant woman with unexplained cardiac symptoms.
• Pneumonia: Infection can lead to both SOB and, in severe cases, cardiac strain indicated by elevated troponin levels. Pregnancy increases the risk of complications from pneumonia.

Do Not Miss Diagnoses

• Aortic Dissection: A life-threatening condition that requires immediate intervention. Pregnancy, particularly in the third trimester, increases the risk due to hormonal effects on the aortic wall. SOB and elevated troponin could be indicative of this condition, especially if accompanied by chest or back pain.
• Amniotic Fluid Embolism (AFE): A rare but highly lethal condition that can occur during pregnancy. It may present with sudden onset of SOB, hypotension, and potentially elevated troponin due to the acute stress on the heart.
• Placental Abruption: While not directly causing elevated troponin, severe placental abruption can lead to significant maternal hypoxia and stress, potentially resulting in cardiac injury.

Rare Diagnoses

• Spontaneous Coronary Artery Dissection (SCAD): More common in women, especially during the postpartum period, but can occur during pregnancy. It presents similarly to MI but is due to a tear in the coronary artery wall.
• Takotsubo Cardiomyopathy: Also known as "stress cardiomyopathy," this condition can mimic MI and is associated with intense emotional or physical stress. It's rare but should be considered in the differential diagnosis of a pregnant woman with unexplained cardiac symptoms.