Differential Diagnosis for 61yo Male with Chest Pressure

• Single Most Likely Diagnosis
  • Anxiety-related chest pressure: The patient's chest pressure occurs mainly with anxiety, suggesting a strong correlation between his anxiety and physical symptoms. This is likely an exacerbation of his existing anxiety disorder.
• Other Likely Diagnoses
  • Gastroesophageal reflux disease (GERD) exacerbation: The patient has a history of GERD and Barrett's esophagus, which could cause chest pressure or discomfort, especially if his GERD is not well-managed.
  • Musculoskeletal chest pain: Given the patient's history of anxiety, it's possible that his chest pressure is related to muscle tension or other musculoskeletal issues.
• Do Not Miss Diagnoses
  • Acute coronary syndrome (ACS): Although the patient's chest pressure is correlated with anxiety, it's crucial to rule out ACS, especially given his history of hypertension (implied by "hld") and family history of atherosclerotic heart disease (ASHD).
  • Pulmonary embolism (PE): While less likely, PE is a potentially life-threatening condition that must be considered, especially if the patient has any additional risk factors (e.g., recent surgery, immobilization).
  • Esophageal rupture or perforation: Although rare, this is a serious condition that could present with chest pain and is more likely in someone with a history of Barrett's esophagus and GERD.
• Rare Diagnoses
  • Esophageal spasm: This condition can cause chest pain and is more likely in someone with a history of esophageal disease (e.g., Barrett's esophagus).
  • Pericarditis: Inflammation of the pericardium can cause chest pain and is a rare but potential diagnosis to consider.