Differential Diagnosis for a 22-year-old Male with Chest Pain, Arm Pain, and Jaw Pain
Single Most Likely Diagnosis
- Acute Coronary Syndrome (ACS): Although less common in young individuals, ACS, including myocardial infarction, should be considered, especially if there are risk factors such as family history, smoking, or hyperlipidemia. The presentation of chest pain radiating to the arm and jaw is classic for cardiac ischemia.
Other Likely Diagnoses
- Musculoskeletal Pain: Strains or overuse injuries could cause pain in the chest, arm, and jaw, especially if the patient has recently engaged in new or strenuous physical activity.
- Gastroesophageal Reflux Disease (GERD): GERD can cause chest pain that may radiate to the jaw and arm, mimicking cardiac pain. It's often associated with eating or lying down.
- Panic Disorder: Panic attacks can cause chest pain, arm pain, and jaw pain, along with other symptoms like shortness of breath and anxiety.
Do Not Miss Diagnoses
- Aortic Dissection: A life-threatening condition where the inner layer of the aorta tears. It can cause severe, tearing chest pain that radiates to the back, arm, or jaw. Although rare in young individuals without predisposing conditions (like Marfan syndrome), it's critical not to miss.
- Pulmonary Embolism: Sudden onset of chest pain, especially if accompanied by shortness of breath, could indicate a pulmonary embolism. This is more likely if there are risk factors such as recent travel, immobility, or family history of clotting disorders.
- Esophageal Rupture: A severe condition that can cause chest pain and may radiate to the jaw or arm, often associated with difficulty swallowing or severe retching.
Rare Diagnoses
- Pericarditis: Inflammation of the pericardium, the sac surrounding the heart, can cause chest pain that may improve with leaning forward and worsen with lying down or deep breathing.
- Costochondritis (Tietze's Syndrome): Inflammation of the cartilage that connects the ribs to the breastbone can cause sharp pains in the chest that may radiate to the arm or jaw.
- Thoracic Outlet Syndrome: Compression of the nerves or blood vessels between the collarbone and first rib can cause pain in the chest, arm, and jaw, often worsened by specific movements of the arm.