Differential Diagnosis for 46 YOM with Central Chest Pain, Troponin 18ng/L, and BP 222/105
- Single Most Likely Diagnosis
- Acute Myocardial Infarction (MI): The patient's central chest pain and elevated troponin level (18ng/L) are highly suggestive of an acute MI. The significantly elevated blood pressure (222/105 mmHg) could be a response to pain or a contributing factor to the MI.
- Other Likely Diagnoses
- Hypertensive Emergency: The patient's severely elevated blood pressure could be causing or contributing to the chest pain, and it requires immediate attention to prevent further organ damage.
- Aortic Dissection: Although less common, the combination of severe hypertension and chest pain raises the possibility of an aortic dissection, which is a serious and potentially life-threatening condition.
- Do Not Miss Diagnoses
- Pulmonary Embolism (PE): While the presentation is more suggestive of cardiac issues, a PE can cause chest pain and elevated troponin levels. Missing this diagnosis could be fatal.
- Cardiac Tamponade: This condition, characterized by fluid accumulation in the pericardial sac, can cause chest pain and hypotension, but the patient's hypertension makes this less likely. However, it's crucial not to miss it due to its high mortality rate if untreated.
- Rare Diagnoses
- Spontaneous Coronary Artery Dissection (SCAD): A rare cause of acute coronary syndrome, SCAD can present with chest pain and elevated troponin levels. It's more common in younger women but should be considered in the differential diagnosis of any patient with suspected MI.
- Takotsubo Cardiomyopathy: Also known as "stress cardiomyopathy," this condition can mimic acute MI with chest pain and elevated troponin levels but is caused by extreme emotional or physical stress. It's less likely given the patient's significantly elevated blood pressure but remains a rare consideration.