Differential Diagnosis for Chest Pain in a 50-year-old Female

Single Most Likely Diagnosis

• Acute Coronary Syndrome (ACS): Given the age and presentation of chest pain, ACS is a leading consideration. Although there's no history of hypertension or diabetes, other risk factors such as hyperlipidemia, family history, or smoking could still predispose her to coronary artery disease.

Other Likely Diagnoses

• Gastroesophageal Reflux Disease (GERD): Chest pain can be a symptom of GERD, especially if it's accompanied by regurgitation or worsens with food intake.
• Musculoskeletal Pain: Costochondritis or musculoskeletal strain can cause chest pain and is relatively common.
• Pulmonary Embolism (PE): Although less likely without specific risk factors mentioned (e.g., recent travel, surgery, or immobilization), PE should be considered, especially if there are respiratory symptoms.
• Pneumonia or Pleuritis: Infections can cause chest pain, especially if there's an associated cough or fever.

Do Not Miss Diagnoses

• Aortic Dissection: A life-threatening condition that requires immediate intervention. Risk factors include hypertension (not present in this case), but it's crucial not to miss due to its high mortality rate.
• Pulmonary Embolism (PE): Reiterated here because, despite being mentioned under other likely diagnoses, it's critical not to miss due to its potential for high morbidity and mortality.
• Esophageal Rupture: Although rare, it's a medical emergency that can present with severe chest pain.

Rare Diagnoses

• Pericarditis: Inflammation of the pericardium can cause chest pain that may improve with leaning forward.
• Pneumothorax: Air in the pleural space can cause sudden onset of chest pain and shortness of breath.
• Esophageal Spasm: Abnormal contractions of the esophagus can mimic cardiac chest pain.

Immediate Treatment

• Oxygen: If saturation is low.
• Aspirin: If ACS is suspected, unless contraindicated.
• Nitrates: For suspected ACS or to help differentiate cardiac from non-cardiac chest pain.
• Morphine: For pain relief in ACS or severe pain.
• ECG: Immediate electrocardiogram to evaluate for signs of ischemia or infarction.
• Troponin: Blood test to assess for cardiac damage.
• Chest X-ray: To evaluate lung fields and cardiac silhouette.
• Further testing (e.g., stress test, echocardiogram, CT angiogram) based on initial findings and clinical suspicion.