Differential Diagnosis for Chest Pain and Arm Discomfort
Single Most Likely Diagnosis
- Musculoskeletal strain: The patient's symptoms started after lifting a heavy barn door, which suggests a mechanical cause for the pain. The normal troponin, D-dimer, CBC, CMP, and EKG results further support this diagnosis, as they rule out more serious cardiac and pulmonary conditions.
Other Likely Diagnoses
- Costochondritis: Inflammation of the cartilage that connects the ribs to the sternum, which can cause chest pain and arm discomfort. The patient's recent physical activity could have triggered this condition.
- Strained or pulled muscle: Similar to musculoskeletal strain, a strained or pulled muscle in the chest or arm could cause the patient's symptoms.
- Acid reflux or gastroesophageal reflux disease (GERD): Strenuous activity can trigger acid reflux, which can cause chest pain and discomfort.
Do Not Miss Diagnoses
- Myocardial infarction (MI): Although the troponin level is normal, it's essential to consider MI, especially if the patient has risk factors. A normal troponin level does not entirely rule out MI, and further evaluation may be necessary.
- Pulmonary embolism (PE): The D-dimer level is normal, but a PE cannot be entirely ruled out without further imaging studies, such as a CT scan. PE is a life-threatening condition that requires prompt diagnosis and treatment.
- Aortic dissection: A tear in the aorta can cause severe chest pain and arm discomfort. Although the patient's symptoms and test results do not strongly suggest this diagnosis, it's crucial to consider it due to its high mortality rate.
Rare Diagnoses
- Pneumothorax: A collapsed lung can cause chest pain and arm discomfort, but it is less likely given the patient's symptoms and normal test results.
- Pericarditis: Inflammation of the sac surrounding the heart can cause chest pain, but it is relatively rare and would likely be associated with other symptoms, such as fever and a pericardial friction rub.