Differential Diagnosis for 24 yo Female with Left Chest Pain

The patient's symptoms and family history suggest a range of possible diagnoses. Here's a categorized differential diagnosis:

• Single Most Likely Diagnosis

  • Mitral Valve Prolapse (MVP): Given the patient's symptoms of left chest pain that worsens in a recumbent position and a mild cough, along with a family history of Wolff-Parkinson-White (WPW) syndrome, which can be associated with cardiac anomalies, MVP is a plausible diagnosis. MVP can cause chest pain, especially when lying down, due to the prolapsing valve leaflets.

• Other Likely Diagnoses

  • Pneumonia or Pulmonary Infection: The presence of a mild cough could suggest a respiratory infection. Although the chest pain worsening in a recumbent position might not be typical for pneumonia, it's essential to consider given the symptom overlap.
  • Gastroesophageal Reflux Disease (GERD): GERD can cause chest pain that worsens when lying down due to stomach acid reflux into the esophagus, irritating it and causing pain.
  • Costochondritis: Inflammation of the cartilage that connects the ribs to the breastbone can cause sharp pains in the chest that might worsen with movement or position changes.

• Do Not Miss Diagnoses

  • Pulmonary Embolism (PE): Although less likely given the patient's age and lack of typical risk factors, PE is a critical diagnosis to consider due to its high mortality rate if untreated. The mild cough could be a symptom, and chest pain that worsens in certain positions might occur.
  • Aortic Dissection: This is a life-threatening condition where there is a tear in the aorta's inner layer. It's crucial to consider, especially with any chest pain, despite being rare in young individuals without predisposing conditions like hypertension or connective tissue disorders.
  • Cardiac Tamponade: Accumulation of fluid in the pericardial space can compress the heart, leading to chest pain, cough, and potentially life-threatening complications if not promptly addressed.

• Rare Diagnoses

  • Ehlers-Danlos Syndrome: A genetic disorder affecting connective tissues, which could potentially explain both the family history of WPW and the patient's symptoms if there's an associated cardiac anomaly or mitral valve prolapse.
  • Marfan Syndrome: Another genetic disorder that affects the body's connective tissue, which can lead to cardiac issues, including mitral valve prolapse and aortic root dilatation, potentially causing chest pain.