Differential Diagnosis for NSTEMI

The following differential diagnosis is organized into categories to help guide the thought process:

• Single Most Likely Diagnosis
  • Acute Coronary Syndrome (ACS) - NSTEMI: This is the most likely diagnosis, as the presentation of chest pain and elevated troponins is consistent with myocardial infarction without ST-segment elevation on the ECG.
• Other Likely Diagnoses
  • Stable Angina: Although less likely than NSTEMI, stable angina can present with similar symptoms and should be considered, especially if the patient has a history of coronary artery disease.
  • Myopericarditis: Inflammation of the myocardium or pericardium can cause chest pain and elevated troponins, mimicking NSTEMI.
  • Pulmonary Embolism: A large pulmonary embolism can cause acute chest pain and troponin elevation due to right ventricular strain.
• Do Not Miss Diagnoses
  • Aortic Dissection: A life-threatening condition that can cause chest pain and should be considered, especially if the patient has a history of hypertension or aortic disease.
  • Pneumothorax: A tension pneumothorax can cause acute chest pain and cardiovascular collapse, making it a critical diagnosis not to miss.
  • Esophageal Rupture: Although rare, esophageal rupture can cause severe chest pain and should be considered in patients with a history of esophageal disease.
• Rare Diagnoses
  • Spontaneous Coronary Artery Dissection (SCAD): A rare cause of myocardial infarction, especially in young women without traditional cardiovascular risk factors.
  • Takotsubo Cardiomyopathy: A condition characterized by transient left ventricular dysfunction, often triggered by stress or emotional events, which can mimic NSTEMI.
  • Coronary Artery Vasospasm: A rare condition that can cause chest pain and troponin elevation due to transient coronary artery spasm.