Differential Diagnosis for Chest Pain with New Onset of Murmur
Single Most Likely Diagnosis
- Acute Coronary Syndrome (ACS) with Papillary Muscle Rupture: This is a likely diagnosis because the new onset of a murmur in the context of chest pain could indicate a mechanical complication of a myocardial infarction, such as papillary muscle rupture leading to mitral regurgitation.
Other Likely Diagnoses
- Myocarditis: Inflammation of the heart muscle can lead to chest pain and the development of a new murmur due to valvular dysfunction or ventricular dysfunction.
- Endocarditis: Infective endocarditis can cause chest pain and the development of a new murmur due to valvular destruction.
- Aortic Dissection: Although typically associated with a tearing chest pain, aortic dissection can lead to a new murmur if the dissection involves the aortic root and causes aortic regurgitation.
Do Not Miss Diagnoses
- Pulmonary Embolism (PE) with Pulmonary Hypertension: A large PE can lead to acute pulmonary hypertension, causing right ventricular strain and potentially a new murmur due to tricuspid regurgitation. Missing this diagnosis can be fatal.
- Aortic Stenosis: Severe aortic stenosis can present with chest pain and a new murmur, and is critical not to miss due to its implications for cardiac output and the need for potential surgical intervention.
Rare Diagnoses
- Cardiac Sarcoidosis: This condition can lead to chest pain and the development of a new murmur due to granulomatous infiltration of the heart, affecting valvular or ventricular function.
- Cardiac Tumors: Although rare, cardiac tumors such as atrial myxomas can cause obstructive symptoms and a new murmur, and can be a source of embolic events.
- Traumatic Heart Injury: Blunt trauma to the chest can result in cardiac contusion or valvular injury, leading to a new murmur and chest pain.