Differential Diagnosis for Chest Pain and Shortness of Breath
The patient presents with chest pain and shortness of breath, which are symptoms that can be associated with a variety of conditions. The following differential diagnosis is organized into categories based on the likelihood and potential severity of the conditions.
Single Most Likely Diagnosis
- Angina Pectoris: This is the most likely diagnosis given the patient's symptoms of intermittent, gripping chest pain, and shortness of breath, especially considering the patient's history of high blood pressure and previous episode of similar symptoms. The fact that the pain is intermittent and has occurred before also supports this diagnosis.
Other Likely Diagnoses
- Hypertensive Crisis: Given the patient's history of elevated blood pressure readings and the current episode of chest pain and shortness of breath, a hypertensive crisis is a possible diagnosis. However, the absence of severely elevated blood pressure readings during the current episode makes this less likely.
- Acute Coronary Syndrome (ACS): Although the patient's symptoms could suggest ACS, the intermittent nature of the pain and the lack of radiation to the jaw or arm make this less likely than angina. However, ACS should still be considered due to the patient's risk factors.
- Pulmonary Embolism (PE): The patient's shortness of breath and chest pain could also suggest a pulmonary embolism, especially if the patient has any underlying risk factors for thromboembolic disease.
Do Not Miss Diagnoses
- Myocardial Infarction (MI): Although the patient's symptoms may not fully align with a classic MI presentation, it is crucial not to miss this diagnosis due to its high morbidity and mortality. The patient's history of high blood pressure and previous similar episode increase the risk.
- Aortic Dissection: This is a life-threatening condition that can present with chest pain and shortness of breath. Although less likely given the patient's symptoms, it is critical to consider due to its high mortality rate if missed.
- Pulmonary Hypertension: Given the patient's symptoms of shortness of breath and chest pain, pulmonary hypertension could be a consideration, especially if there are underlying conditions that could lead to this diagnosis.
Rare Diagnoses
- Pericarditis: This condition can cause chest pain and shortness of breath, but it is less common and would typically be associated with a pericardial friction rub on physical examination.
- Cardiac Sarcoma: Although extremely rare, cardiac tumors can cause chest pain and shortness of breath due to obstruction or invasion of cardiac structures.
- Mitral Valve Prolapse: While not typically presenting with the symptoms described, in rare cases, mitral valve prolapse can lead to chest pain and shortness of breath, especially if there is significant mitral regurgitation.