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Differential Diagnosis for a 24-week Pregnant Woman with Chest Pain and SOB

Single Most Likely Diagnosis

  • Preeclampsia: Given the patient's symptoms of chest pain, shortness of breath (SOB), pain to the right upper quadrant (RUQ), headache, and abdominal cramping, along with a history of type 2 diabetes mellitus (T2DM), preeclampsia is a strong consideration. Although the blood pressure (BP) is currently within a normal range, preeclampsia can present with a wide range of blood pressure values, and the presence of symptoms such as headache and abdominal pain, especially in the context of pregnancy, warrants its consideration.

Other Likely Diagnoses

  • Gastroesophageal Reflux Disease (GERD): Pregnancy can exacerbate GERD symptoms, which include chest pain and discomfort, potentially radiating to the RUQ, and could contribute to shortness of breath.
  • Pulmonary Embolism (PE): Although less likely given the negative troponin and the absence of specific risk factors mentioned, PE remains a consideration in pregnant women due to the hypercoagulable state of pregnancy.
  • Musculoskeletal Chest Pain: The strain on the chest wall and musculoskeletal system during pregnancy can lead to chest pain, which might be exacerbated by the patient's T2DM.

Do Not Miss Diagnoses

  • Myocardial Infarction (MI): Despite the negative troponin, MI should not be entirely ruled out without further evaluation, especially considering the patient's T2DM, which increases cardiovascular risk. Repeat troponin levels and further cardiac evaluation might be necessary.
  • Aortic Dissection: This is a rare but life-threatening condition that can present with chest pain and should be considered, especially if the pain is severe and tearing in nature.
  • Placental Abruption: Abdominal pain and cramping could be indicative of placental abruption, a condition where the placenta separates from the uterus, which is a medical emergency.

Rare Diagnoses

  • Peripartum Cardiomyopathy: A rare condition where the heart muscle becomes weakened and cannot function properly, occurring during the last month of pregnancy or within 5 months after delivery.
  • Spontaneous Coronary Artery Dissection (SCAD): A rare cause of myocardial infarction that is more common in women, especially during pregnancy or postpartum.

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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