Differential Diagnosis for a 61-year-old with AHDA (Atherosclerotic Heart Disease with Angina)
- Single most likely diagnosis:
- Stable Angina: This is the most likely diagnosis given the patient's age and the presence of atherosclerotic heart disease. Stable angina is characterized by predictable patterns of chest pain, typically triggered by exertion or emotional stress and relieved by rest or nitroglycerin.
- Other Likely diagnoses:
- Unstable Angina: This condition presents with a change in the pattern of angina, such as more frequent, severe, or prolonged episodes, and may occur at rest. It indicates a more unstable plaque and increased risk of myocardial infarction.
- Myocardial Infarction (MI): Although the question specifies angina, any change in the character of chest pain or the presence of other symptoms like shortness of breath, nausea, or radiation of pain could suggest an MI.
- Do Not Miss diagnoses:
- Aortic Dissection: Although less common, aortic dissection is a life-threatening condition that can present with sudden, severe chest pain that may radiate to the back. It's crucial to consider this diagnosis, especially if the pain is described as tearing or ripping.
- Pulmonary Embolism (PE): PE can present with sudden onset of chest pain, especially if it's associated with shortness of breath, cough, or recent history of immobility. It's a critical diagnosis to consider due to its high mortality rate if untreated.
- Rare diagnoses:
- Coronary Artery Spasm (Prinzmetal’s Angina): This condition involves transient coronary artery spasm leading to chest pain, often at rest and without a clear precipitant. It's less common and can be challenging to diagnose.
- Pericarditis: Inflammation of the pericardium can cause chest pain that may mimic angina but is often sharper and may improve with sitting up and leaning forward. It's a less common cause of chest pain but should be considered, especially if there are systemic symptoms like fever.