Differential Diagnosis for New Onset rS Waves in Lead II, III, and AVF with Epigastric and RLQ Pain
Single Most Likely Diagnosis
- Acute Coronary Syndrome (ACS), specifically Inferior Wall Myocardial Infarction (IWMI): The new onset rS waves in leads II, III, and AVF are indicative of an inferior wall myocardial infarction. The epigastric and right lower quadrant (RLQ) pain can sometimes be referred pain from the inferior wall of the heart due to shared nerve roots.
Other Likely Diagnoses
- Gastroesophageal Reflux Disease (GERD) or Peptic Ulcer Disease (PUD): These conditions can cause epigastric pain and may occasionally be associated with electrocardiogram (ECG) changes due to vagal stimulation or other mechanisms, though they are less likely to cause specific rS wave changes in the mentioned leads.
- Cholecystitis or Biliary Colic: While primarily causing right upper quadrant pain, in some cases, the pain can radiate or be referred to the epigastric area or even the back, and though less common, could potentially cause ECG changes due to pain-induced stress or other mechanisms.
Do Not Miss Diagnoses
- Pulmonary Embolism (PE): Although the ECG findings are not typical for PE, the condition can present with a wide range of symptoms including chest pain and can be life-threatening if missed. The pain pattern can sometimes be atypical, including epigastric or abdominal pain.
- Aortic Dissection: This is a medical emergency that can present with a variety of symptoms including severe, tearing chest pain that may radiate to the back or abdomen. While the ECG findings mentioned are not specific for aortic dissection, it's a condition that must be considered due to its high mortality if not promptly treated.
Rare Diagnoses
- Pericarditis: This condition can cause chest pain and ECG changes, but the specific pattern of rS waves in leads II, III, and AVF is not typical. Pericarditis usually presents with widespread ST elevation on the ECG.
- Cardiac Tumors or Other Rare Cardiac Conditions: These could potentially cause ECG abnormalities and pain, but are much less common and would typically be considered after more common causes have been ruled out.