Differential Diagnosis for Chest Pain in a 20-year-old Female
Single Most Likely Diagnosis
- Costochondritis: This condition is characterized by sharp pains in the chest, often localized to one side, which matches the patient's description of left-sided, constant, sharp pain. The recent replenishment of magnesium and the focus on her shaking and dizziness during the previous ED visit might suggest muscle-related issues, and costochondritis is a common cause of chest pain in young adults.
Other Likely Diagnoses
- Musculoskeletal Pain: Given the patient's recent history of shaking and dizziness, which was treated with magnesium replenishment, it's plausible that her chest pain is related to musculoskeletal issues, possibly exacerbated by or related to the same underlying condition that caused her previous symptoms.
- Anxiety or Panic Disorder: The patient's presentation with chest pain, tachycardia (HR 125), and a history of shaking and dizziness could also suggest an anxiety or panic disorder, which are common in young adults and can manifest with chest pain.
- Pulmonary Embolism (PE) or Pneumonia: Although less likely given the patient's age and lack of specific risk factors, these conditions cannot be ruled out without further evaluation, especially considering the patient's tachycardia and recent onset of symptoms.
Do Not Miss Diagnoses
- Myocardial Infarction (MI): Although rare in young adults without cardiac history, MI is a "do not miss" diagnosis due to its high mortality if not promptly treated. The patient's chest pain and tachycardia warrant consideration of this diagnosis.
- Aortic Dissection: This is a life-threatening condition that requires immediate diagnosis and treatment. Although rare and less likely in a 20-year-old without known risk factors, the severe, sharp nature of the chest pain necessitates its consideration.
- Pulmonary Embolism (PE): Mentioned again due to its potential severity and the need for prompt anticoagulation if diagnosed.
Rare Diagnoses
- Pneumothorax: Could present with sharp chest pain and is a consideration, especially if there's a history of lung disease or recent trauma, though the patient's SpO2 is normal.
- Pericarditis: Inflammation of the pericardium can cause sharp chest pain, often improving with leaning forward. It's less common but should be considered in the differential diagnosis of chest pain.
Labs and Studies to Evaluate this Patient
- ECG: To evaluate for signs of ischemia or pericarditis, although the patient had a reportedly normal EKG during her previous visit.
- Troponin Levels: To rule out myocardial infarction, even though the patient is young and without known cardiac risk factors.
- D-dimer: If there's a suspicion of pulmonary embolism, although its utility is limited by the patient's recent presentation and potential for false positives.
- Chest X-ray: To evaluate for pneumonia or pneumothorax.
- Blood Work: Including complete blood count (CBC), electrolytes, and magnesium level to assess for any abnormalities that could contribute to her symptoms.
- Echocardiogram: If there's suspicion of cardiac involvement or if initial evaluations suggest a need for further cardiac assessment.
- CT Pulmonary Angiogram (CTPA) or Ventilation-Perfusion Scan: If pulmonary embolism is highly suspected after initial evaluations.