Differential Diagnosis

The patient presents with a complex array of symptoms including irregular menstrual cycles, severe menstrual pain, muscle pain, chest pain, and throat tension. Considering these symptoms, the differential diagnosis can be categorized as follows:

• Single Most Likely Diagnosis
  • Dysmenorrhea: This condition is characterized by severe menstrual cramps, which aligns with the patient's complaint of severe menstrual pain. The presence of heavy bleeding and headaches during periods further supports this diagnosis. Dysmenorrhea is a common condition in adolescents and young adults, making it a likely explanation for the patient's symptoms.
• Other Likely Diagnoses
  • Premenstrual Dysphoric Disorder (PMDD): Given the patient's history of possible depression and the exacerbation of symptoms during menstruation, PMDD is a plausible diagnosis. PMDD is characterized by severe mood and physical symptoms that are linked to the menstrual cycle.
  • Fibromyalgia: The patient's complaint of ongoing muscle pain without periods could suggest fibromyalgia, a condition characterized by widespread musculoskeletal pain accompanied by fatigue, sleep, memory, and mood issues.
  • Anxiety Disorder: The patient's symptoms of throat tension when swallowing water and possible palpitations could indicate an anxiety disorder, which might be contributing to or exacerbating the other symptoms.
• Do Not Miss Diagnoses
  • Cardiac Conditions (e.g., Pericarditis, Myocarditis): Chest pain, even if occasional and not clearly linked to exertion, must be thoroughly investigated, especially in the context of possible palpitations. Cardiac conditions can be life-threatening and require immediate attention.
  • Pulmonary Embolism: Although less common in this age group, pulmonary embolism can present with chest pain and cough. Given the patient's history of vaping and occasional smoking, this diagnosis should not be overlooked.
  • Endometriosis: While not immediately life-threatening, endometriosis can cause severe menstrual pain, heavy bleeding, and infertility if left untreated. It's a significant condition to consider given the patient's symptoms.
• Rare Diagnoses
  • Hypermobile Ehlers-Danlos Syndrome: This condition can present with joint hypermobility, musculoskeletal pain, and gastrointestinal symptoms. Although rare, it could explain some of the patient's symptoms, including muscle pain and possibly the throat tension.
  • Mitral Valve Prolapse: A condition that can cause chest pain, palpitations, and is sometimes associated with fibromyalgia and anxiety disorders. It's less common but should be considered in the differential diagnosis given the patient's cardiac symptoms.

Each of these diagnoses requires careful consideration and further investigation to determine the underlying cause of the patient's symptoms. A comprehensive approach, including physical examination, laboratory tests, and possibly imaging studies, will be necessary to narrow down the differential diagnosis and establish a definitive diagnosis.