Differential Diagnosis for Sudden Onset of Dyspnea and Chest Pain

Given the clinical presentation of a 67-year-old woman with sudden onset of dyspnea and chest pain leading to rapid death, with a history of Stage IV ovarian cancer and recent bedridden status, the following differential diagnoses are considered:

• Single Most Likely Diagnosis

  • Pulmonary Embolism (PE): The patient's recent history of being bedridden for 2 months significantly increases her risk for deep vein thrombosis (DVT) and subsequent pulmonary embolism. The sudden onset of dyspnea and chest pain, followed by rapid death, is consistent with a large or saddle PE, which is a well-known complication in patients with cancer and immobility.

• Other Likely Diagnoses

  • Myocardial Infarction (MI): Although less likely than PE given the context, an MI could present with sudden chest pain and dyspnea. The stress of cancer and possible comorbid conditions increase the risk of cardiac events.
  • Pneumonia: Given the patient's bedridden status, she is at increased risk for aspiration pneumonia or other types of pneumonia, which could lead to severe respiratory distress and death.
  • Cardiac Tamponade: Metastatic cancer can involve the heart, leading to effusions and potentially life-threatening tamponade physiology.

• Do Not Miss Diagnoses

  • Aortic Dissection: Although less common, an aortic dissection is a catastrophic event that presents with sudden chest pain and could lead to rapid death. It's crucial to consider this diagnosis due to its high mortality rate if missed.
  • Tension Pneumothorax: This condition requires immediate recognition and treatment. It could occur spontaneously or as a complication of lung cancer metastasis and would present with sudden onset of dyspnea and chest pain.

• Rare Diagnoses

  • Pulmonary Arterial Hypertension Crisis: This is a rare but potentially fatal condition that could present with sudden dyspnea and chest pain. It might be associated with various conditions, including cancer.
  • Fat Embolism Syndrome: Although more commonly associated with long bone fractures, fat embolism could theoretically occur in the context of cancer, especially with bone metastases, and present with respiratory distress among other symptoms.
  • Catastrophic Pulmonary Hemorrhage: This could be due to various causes, including cancer (e.g., metastatic disease to the lungs), anticoagulation therapy, or vasculitis, and would present with sudden onset of dyspnea and potentially hemoptysis.