Differential Diagnosis for Intermittent Chest Pain with QRS End Nothing (Presumably QRS Complex Abnormalities)

Single Most Likely Diagnosis

• Angina Pectoris: This condition is characterized by intermittent chest pain due to transient myocardial ischemia, often related to coronary artery disease. The QRS complex abnormalities could be indicative of myocardial ischemia or previous infarction.

Other Likely Diagnoses

• Myocardial Infarction (MI): Although typically presenting with more persistent pain, some MIs can cause intermittent chest pain. QRS changes can indicate areas of infarction or ischemia.
• Pericarditis: Inflammation of the pericardium can cause sharp, intermittent chest pain and may lead to ECG changes, including those affecting the QRS complex.
• Hypertrophic Cardiomyopathy: This condition can cause chest pain due to myocardial ischemia and may show various ECG abnormalities, including QRS changes.

Do Not Miss Diagnoses

• Pulmonary Embolism (PE): While PE typically presents with sudden onset dyspnea, it can also cause chest pain. ECG changes are not specific but can include right ventricular strain patterns. Missing this diagnosis can be fatal.
• Aortic Dissection: A life-threatening condition that can cause severe, tearing chest pain. ECG changes might not be specific, but the diagnosis must be considered due to its high mortality rate.
• Cardiac Tamponade: Accumulation of fluid in the pericardial sac can compress the heart, leading to reduced cardiac output. It can present with chest pain and ECG changes, including low voltage QRS complexes.

Rare Diagnoses

• Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC): A rare condition that affects the right ventricle, leading to arrhythmias and possible chest pain. ECG changes can include T wave inversions in the right precordial leads and epsilon waves.
• Brugada Syndrome: Characterized by specific ECG patterns (including QRS complex abnormalities) and can lead to life-threatening arrhythmias. Chest pain is not a primary symptom but can occur.
• Mitral Valve Prolapse: While often asymptomatic, it can cause chest pain, and ECG changes might include those affecting the QRS complex due to associated conditions like mitral regurgitation.