A 25-year-old woman is evaluated in the emergency department for mild shortness of breath and right lateral chest pain of 2 days' duration. She reports no orthopnea or lower extremity edema. Her medical history is unremarkable other than anxiety related to meeting the demands of her new job as an engineer. She takes no medications. On physical examination, she is in no apparent distress. Vital signs are normal, and oxygen saturation is 99%.

Which of the following is the most appropriate next step in her evaluation?

1. CT angiography of the chest
2. D-dimer
3. Echocardiography
4. No further testing

The patient could undergo a D-dimer test to rule out thromboembolic disorders, such as a pulmonary embolism. A CT angiography would provide more insight if the D-dimer is high. Her symptoms could also be a manifestation of anxiety.

Explanation:

The 25-year-old woman's symptoms indicate shortness of breath, which doesn't seem to be related to any known medical condition she has. Given her age, it is less probable she is dealing with an acute myocardial infarction (MI), which commonly presents with difficulty breathing and chest pain sometimes mistaken for anxiety in women. Males often experience pain radiating down the left arm. In female patients, these symptoms may not necessarily appear.

Given her symptoms, a good first diagnostic step would be a D-dimer test. This can aid in the diagnosis of thromboembolic disorders such as pulmonary embolism (PE), which can cause shortness of breath and chest discomfort. If the D-dimer is elevated, a CT angiography would be necessary to visualize the pulmonary arteries.

It's important to note her symptoms could also be due to her anxiety, especially if her tests return normal results.

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