Differential Diagnosis for Chest Pain with Negative Cardiac Catheter in a 34-year-old Male
Single Most Likely Diagnosis
- Gastroesophageal Reflux Disease (GERD): This is a common cause of chest pain in young adults, especially if the pain is related to eating or relieved by antacids. The negative cardiac catheterization result reduces the likelihood of coronary artery disease, making GERD a more probable diagnosis.
Other Likely Diagnoses
- Musculoskeletal Chest Pain: This includes conditions like costochondritis or muscle strain, which can cause chest pain that mimics cardiac issues. The patient's age and the absence of cardiac disease on catheterization make this a plausible explanation.
- Anxiety or Panic Disorder: These conditions can cause chest pain or discomfort, especially in younger adults. A negative cardiac workup might lead to considering psychiatric causes, especially if there are accompanying symptoms like palpitations, shortness of breath, or fear of dying.
- Pulmonary Embolism (less likely due to age but still possible): Although less common in a young adult without risk factors, pulmonary embolism should be considered, especially if there are symptoms like shortness of breath or risk factors for thromboembolism.
Do Not Miss Diagnoses
- Aortic Dissection: Although rare, especially in a young adult without hypertension or connective tissue disease, aortic dissection is a life-threatening condition that must be ruled out. The absence of coronary artery disease does not exclude this diagnosis.
- Pulmonary Hypertension: This condition can cause chest pain and has a varied presentation. It's crucial to consider, especially if there are symptoms like progressive shortness of breath.
- Coronary Artery Spasm (Prinzmetal’s Angina): This condition can cause chest pain and may not be evident on a cardiac catheterization if the spasm is not occurring at the time of the procedure.
Rare Diagnoses
- Pericarditis: Inflammation of the pericardium can cause chest pain that may mimic myocardial infarction. It's less common but should be considered, especially if there's a history of recent viral illness or autoimmune disease.
- Esophageal Spasm or Esophageal Rupture: These are less common causes of chest pain but can be severe. Esophageal rupture is a medical emergency.
- Pneumothorax: Although more commonly associated with shortness of breath, a pneumothorax can cause chest pain and should be considered, especially if there's a history of lung disease or recent trauma.