Differential Diagnosis
- Single most likely diagnosis
- Asthma exacerbation: The patient has a history of asthma, and her symptoms of nonproductive cough, chest tightness, and shortness of breath, particularly at night, are consistent with asthma. The fact that she has not experienced symptoms or needed an inhaler since her late teenage years does not rule out the possibility of an exacerbation, especially during pregnancy when asthma symptoms can worsen.
- Other Likely diagnoses
- Pregnancy-related respiratory changes: Pregnancy can cause respiratory symptoms due to the enlarging uterus pushing on the diaphragm and increased progesterone levels, which can lead to increased respiratory rate and depth. However, these symptoms are typically more pronounced in the third trimester.
- Gastroesophageal reflux disease (GERD): Although the patient's symptoms are not worse during meals or while lying down, GERD can still cause respiratory symptoms like cough and shortness of breath, especially at night.
- Anxiety or panic disorder: The patient's symptoms of chest tightness and shortness of breath could be related to anxiety or panic disorder, particularly if she is experiencing stress or anxiety related to her pregnancy.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Pulmonary embolism: Although the patient is asymptomatic during her visit and has no known risk factors for pulmonary embolism, it is essential to consider this diagnosis due to its high mortality rate. Pregnancy increases the risk of pulmonary embolism, and symptoms can be nonspecific.
- Pneumonia: The patient's symptoms of cough and shortness of breath could be indicative of pneumonia, which can be serious during pregnancy. It is crucial to consider this diagnosis, even if the patient appears asymptomatic during the visit.
- Rare diagnoses
- Idiopathic pulmonary fibrosis: This rare condition can cause respiratory symptoms like cough and shortness of breath, but it is unlikely in a young patient without a history of exposure to known pulmonary toxins.
- Cardiac disease: Although the patient's blood pressure and pulse are normal, it is essential to consider cardiac disease, such as peripartum cardiomyopathy, which can cause respiratory symptoms like shortness of breath. However, this diagnosis is less likely in a patient without other cardiac risk factors.