Differential Diagnosis for 31-year-old Male with Chest Pain
- Single most likely diagnosis:
- Viral gastroenteritis with dehydration and subsequent electrolyte imbalance leading to chest pain: The patient's symptoms of nausea, diarrhea, and abdominal cramping, along with the recent history of limited solid and liquid intake, suggest viral gastroenteritis. Dehydration and electrolyte imbalances can lead to symptoms such as dizziness, fatigue, and chest pain, especially if there is an associated pericarditis or myocardial irritability.
- Other Likely diagnoses:
- Acute viral pericarditis: The patient's chest pain worsens with deep breathing, which is a classic symptom of pericarditis. Viral pericarditis can be associated with gastrointestinal symptoms and could explain the patient's presentation.
- Gastroesophageal reflux disease (GERD): The patient's midsternal chest pain could be related to GERD, especially if the nausea and diarrhea have led to increased intra-abdominal pressure and subsequent reflux.
- Costochondritis: The patient's chest pain could be musculoskeletal in nature, especially if the patient has been experiencing increased coughing or straining due to the gastrointestinal symptoms.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.):
- Acute coronary syndrome (ACS): Although the patient is young, it is essential to consider ACS, especially if there are any underlying risk factors or if the patient has a family history of early coronary artery disease.
- Pulmonary embolism (PE): The patient's dizziness and chest pain could be indicative of a PE, especially if there has been any recent immobilization or if the patient has a history of clotting disorders.
- Aortic dissection: The patient's chest pain and dizziness could be indicative of an aortic dissection, although this is less likely given the patient's age and lack of other risk factors.
- Rare diagnoses:
- Spontaneous coronary artery dissection (SCAD): This is a rare condition that can cause ACS, especially in young women, but can also occur in men.
- Esophageal rupture or perforation: The patient's chest pain and gastrointestinal symptoms could be indicative of an esophageal rupture or perforation, although this is less likely given the lack of severe pain or vomiting.