Clinical Practice and Cases in Emergency Medicine

Introduction: Recurrent chest pain in postpartum patients frequently results in repeated emergency department (ED) visits despite negative cardiopulmonary investigations, creating diagnostic uncertainty and increasing healthcare resource utilization. We report a case highlighting the value of a structured postexclusion assessment to identify clinically relevant behavioral triggers after life-threatening causes have been excluded.

Case Report: A 33-year-old woman, six weeks postpartum, presented repeatedly with nocturnal chest pain, palpitations, and dyspnea. Serial electrocardiograms, cardiac biomarkers, chest imaging, and transthoracic echocardiography were consistently normal, excluding acute cardiopulmonary pathology. Careful reassessment of symptom chronology and behavioral history identified a reproducible temporal association between symptom onset and nocturnal binge-eating episodes. Following outpatient psychiatric and clinical psychological evaluation confirming Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, diagnostic criteria for binge-eating disorder, targeted behavioral counseling led to a marked reduction in symptom frequency and no further ED presentations during follow-up.

Conclusion: This case demonstrates that, after exclusion of life-threatening cardiopulmonary disease, a structured assessment emphasizing symptom temporality and behavioral triggers can uncover clinically actionable mechanisms underlying recurrent postpartum chest pain. Incorporating this approach into emergency department evaluation may facilitate appropriate management while reducing unnecessary repeat investigations and ED utilization.