Differential Diagnosis for Chest Pain and Rapid Heart Rate

The patient's symptoms of chest pain, rapid heart rate, and social history of daily alcohol consumption and illicit drug use require a comprehensive differential diagnosis. The following categories organize potential diagnoses based on likelihood and severity:

• Single Most Likely Diagnosis
  • Cocaine-induced cardiotoxicity: The patient's symptoms of chest pain, rapid heart rate, hypertension, and agitation, combined with a history of illicit drug use, make cocaine-induced cardiotoxicity the most likely diagnosis. Cocaine use is known to cause coronary artery vasoconstriction, myocardial ischemia, and arrhythmias, which can lead to myocardial infarction.
• Other Likely Diagnoses
  • Alcohol withdrawal: The patient's history of daily alcohol consumption and current agitation, diaphoresis, and tachycardia suggest possible alcohol withdrawal. However, the presence of chest pain and hypertension makes this diagnosis less likely.
  • Stimulant-induced psychosis or anxiety: The patient's agitation and diaphoresis could be attributed to stimulant-induced psychosis or anxiety, but the chest pain and rapid heart rate suggest a more severe cardiac-related condition.
• Do Not Miss Diagnoses
  • Myocardial infarction: Although the patient is young, the combination of chest pain, rapid heart rate, and hypertension requires consideration of myocardial infarction, especially given the potential for cocaine-induced cardiotoxicity.
  • Pulmonary embolism: Although less likely, pulmonary embolism can cause chest pain and rapid heart rate, and it is essential to consider this diagnosis, especially if the patient has a history of deep vein thrombosis or other risk factors.
  • Endocarditis: The patient's history of illicit drug use increases the risk of endocarditis, which can cause fever, chest pain, and cardiac symptoms.
• Rare Diagnoses
  • Hypertrophic cardiomyopathy: This condition can cause chest pain, rapid heart rate, and hypertension, but it is less likely given the patient's age and lack of family history.
  • Pneumonia or other infectious causes: Although the patient has a fever, the absence of other respiratory symptoms makes pneumonia or other infectious causes less likely. However, it is essential to consider these diagnoses, especially if the patient's condition worsens or does not respond to treatment.