Differential Diagnosis for Chest Pain and Numbness in the Right Arm

Single Most Likely Diagnosis

• Acute Coronary Syndrome (ACS): This is the most likely diagnosis given the combination of chest pain and numbness in the arm, which could be referred pain from cardiac ischemia. The presentation is classic for myocardial infarction (MI), where the numbness or pain in the arm can be a radiation of pain from the chest.

Other Likely Diagnoses

• Musculoskeletal Pain: Conditions such as costochondritis or musculoskeletal strain could cause chest pain and, if the strain involves the shoulder or upper back, could potentially radiate to the arm.
• Panic Attack: Panic attacks can cause chest pain and numbness or tingling sensations in the extremities, including the arms, due to hyperventilation and anxiety.
• Gastroesophageal Reflux Disease (GERD): GERD can cause chest pain that may radiate to the arms, though numbness is less commonly associated with this condition.

Do Not Miss Diagnoses

• Aortic Dissection: Although less common, an aortic dissection is a life-threatening condition that can cause severe chest pain and, depending on the location of the dissection, could lead to neurological symptoms including numbness in an arm.
• Pulmonary Embolism (PE): A PE can cause sudden onset chest pain and, if large enough, could lead to decreased cardiac output and subsequent decreased perfusion to the limbs, potentially causing numbness.
• Stroke: While less directly related to chest pain, a stroke could cause numbness in an arm. If the stroke involves areas that affect the heart (such as the insula), it could potentially cause cardiac symptoms including chest pain.

Rare Diagnoses

• Thoracic Outlet Syndrome: This condition involves compression of the nerves and/or blood vessels that pass into the thoracic outlet (the space between your collarbone and first rib), which can cause pain in your shoulders and neck and numbness in your fingers.
• Cervical Disc Disease: Herniation of a cervical disc can cause numbness in the arm due to compression of the spinal nerves. If the condition causes enough pain and inflammation, it could potentially refer pain to the chest.
• Tietze's Syndrome: An inflammatory condition of the cartilages and surrounding tissues of the ribs, which can cause chest pain and, if the inflammation involves the areas near the arm, could potentially cause radiating pain or numbness.