Differential Diagnosis for Chest Pain with Radiation to Jaw and ST Elevation
- Single most likely diagnosis:
- Acute Coronary Syndrome (ACS) with Microvascular Dysfunction or Coronary Spasm: Although the angiogram is normal, the presence of ST elevation in leads 2,3, and V6, along with chest pain radiating to the jaw, suggests an acute coronary event. Microvascular dysfunction or coronary spasm could explain the normal angiogram findings.
- Other Likely diagnoses:
- Pericarditis: The presence of ST elevation in multiple leads, including V6, could be indicative of pericarditis, especially if the patient has a pericardial friction rub. However, the radiation of pain to the jaw is less typical for pericarditis.
- Pulmonary Embolism (PE) with Cardiac Involvement: Although less common, a large PE can cause cardiac strain, leading to ST elevation and chest pain. The absence of typical PE symptoms (e.g., dyspnea, tachypnea) makes this less likely, but it should be considered.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.):
- Aortic Dissection: This is a life-threatening condition that can cause chest pain radiating to the jaw, although it typically presents with a tearing or ripping sensation. The normal angiogram does not entirely rule out aortic dissection, as it may not visualize the aorta.
- Pulmonary Embolism (PE): As mentioned earlier, a large PE can cause cardiac strain and ST elevation. It's essential to consider PE, especially if the patient has risk factors (e.g., recent surgery, immobilization, family history).
- Rare diagnoses:
- Myopericarditis: This condition involves inflammation of both the myocardium and pericardium, which can cause ST elevation and chest pain. However, it is relatively rare and often associated with viral infections or autoimmune disorders.
- Takotsubo Cardiomyopathy: Also known as "stress cardiomyopathy," this condition can cause ST elevation and chest pain, often triggered by intense emotional or physical stress. The normal angiogram and absence of significant coronary disease make this a less likely but possible diagnosis.