Differential Diagnosis for Chest Pain with ST Elevation
Single Most Likely Diagnosis
- Acute Pericarditis: This condition is characterized by inflammation of the pericardium, which can cause chest pain and ST elevation on ECG. The normal angiogram result reduces the likelihood of an acute coronary syndrome, making pericarditis a more plausible explanation for the symptoms.
Other Likely Diagnoses
- Myocarditis: Inflammation of the myocardium can cause chest pain, ST elevation, and normal coronary arteries on angiogram. The clinical presentation and ECG findings can be similar to those of acute pericarditis.
- Takotsubo Cardiomyopathy: Also known as stress cardiomyopathy, this condition can cause chest pain, ST elevation, and transient left ventricular dysfunction, often with normal coronary arteries.
- Coronary Artery Spasm: Although the angiogram is normal, coronary artery spasm can cause transient ST elevation and chest pain, which may not be visible on a standard angiogram.
Do Not Miss Diagnoses
- Aortic Dissection: Although less likely, aortic dissection is a life-threatening condition that can cause chest pain and ST elevation. It is essential to consider this diagnosis, especially if there are other symptoms such as a tearing sensation or unequal blood pressures in the arms.
- Pulmonary Embolism: A large pulmonary embolism can cause chest pain, ST elevation, and normal coronary arteries on angiogram. This diagnosis should be considered, especially if there are other symptoms such as shortness of breath or tachycardia.
Rare Diagnoses
- Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC): A rare condition characterized by fibrofatty replacement of the right ventricular myocardium, which can cause chest pain, ST elevation, and normal coronary arteries.
- Left Ventricular Hypertrophy with Strain Pattern: Severe left ventricular hypertrophy can cause ST elevation and chest pain, although this is a less common explanation for the symptoms.
- Early Repolarization Syndrome: A benign condition that can cause ST elevation on ECG, although it is typically asymptomatic and not associated with chest pain.