Differential Diagnosis for Recurrent Chest Pain with Negative Cardiac Workup
Single Most Likely Diagnosis
- Vasovagal Syncope: This condition is characterized by recurrent episodes of chest pain, hypotension, bradycardia, and trembling, which are triggered by a vagal response. The negative cardiac workup and the presence of bradycardia and hypotension support this diagnosis.
Other Likely Diagnoses
- Anxiety or Panic Disorder: These conditions can cause chest pain, trembling, and hypotension, and are often associated with a negative cardiac workup. The presence of bradycardia is less common, but can occur in response to intense anxiety.
- Gastroesophageal Reflux Disease (GERD): GERD can cause chest pain and is often associated with a negative cardiac workup. While it is less likely to cause hypotension and bradycardia, it is a common condition that can cause significant symptoms.
- Pulmonary Embolism (with a negative initial workup): Although the initial cardiac workup was negative, a pulmonary embolism can cause recurrent chest pain, hypotension, and bradycardia. A high index of suspicion is necessary to diagnose this condition.
Do Not Miss Diagnoses
- Cardiac Tamponade: This is a life-threatening condition that can cause chest pain, hypotension, and bradycardia. Although the cardiac workup was negative, cardiac tamponade can be a subtle diagnosis that requires a high index of suspicion.
- Aortic Dissection: This is a life-threatening condition that can cause chest pain, hypotension, and bradycardia. Although the initial workup was negative, aortic dissection can be a subtle diagnosis that requires a high index of suspicion.
- Pheochromocytoma: This is a rare tumor that can cause episodic hypertension, tachycardia, and chest pain. However, it can also cause hypotension and bradycardia in some cases, making it a "do not miss" diagnosis.
Rare Diagnoses
- Mitral Valve Prolapse: This condition can cause chest pain, hypotension, and bradycardia, but is less likely to cause recurrent episodes of these symptoms.
- Hypothyroidism: This condition can cause chest pain, hypotension, and bradycardia, but is less likely to cause recurrent episodes of these symptoms.
- Autonomic Dysfunction: This is a rare condition that can cause a variety of symptoms, including chest pain, hypotension, and bradycardia. However, it is often associated with other symptoms, such as orthostatic hypotension and syncope.