Differential Diagnosis for 64-year-old Female with Anterior Chest Pain
- Single most likely diagnosis:
- Acute Coronary Syndrome (ACS): The patient's symptoms of anterior chest pain radiating to the back, described as heavy pressure, and the presence of a significant family history of cardiac events, make ACS a likely diagnosis. Although she took aspirin, the pain has not changed, which could indicate an ongoing cardiac issue.
- Other Likely diagnoses:
- Pulmonary Embolism (PE): The pain worsening with deep breaths could suggest a pulmonary cause. However, the lack of shortness of breath or other typical symptoms makes this less likely.
- Musculoskeletal Chest Pain: The fact that the pain is more prominent with deep breathing could also indicate a musculoskeletal origin, especially given the absence of other systemic symptoms.
- Gastroesophageal Reflux Disease (GERD): Although less likely given the description of the pain, GERD can cause chest pain that may radiate to the back.
- Do Not Miss diagnoses:
- Aortic Dissection: This is a life-threatening condition that can present with sudden onset of chest pain radiating to the back. The absence of typical symptoms like tearing pain or a significant difference in blood pressure between arms does not rule out this diagnosis.
- Pulmonary Embolism (also listed under other likely diagnoses due to its potential presentation, but included here for emphasis on not missing it): Despite the lack of typical symptoms, PE is a critical diagnosis to consider due to its high mortality rate if untreated.
- Cardiac Tamponade: Although less likely without symptoms of shock or significant shortness of breath, cardiac tamponade can present with chest pain and is a life-threatening condition.
- Rare diagnoses:
- Spontaneous Coronary Artery Dissection (SCAD): A rare cause of ACS, more common in women without traditional cardiovascular risk factors.
- Esophageal Rupture: A rare but serious condition that could present with severe chest pain, especially if there was a history of vomiting or other esophageal disease.