Differential Diagnosis for a 16-year-old Boy with Intermittent Atypical Chest Pains and Syncope
Single most likely diagnosis:
- Hypertrophic Cardiomyopathy (HCM): This condition is a leading cause of sudden cardiac death in young athletes. The symptoms of sharp chest pain followed by syncope (loss of consciousness), especially during physical exertion like playing football, are consistent with HCM. The mechanism involves obstruction of the left ventricular outflow tract, which can lead to reduced cardiac output and subsequent syncope.
Other Likely diagnoses:
- Long QT Syndrome: A disorder of the heart's electrical activity that can cause sudden, uncontrollable, dangerous arrhythmias. Symptoms can include syncope, especially during physical activity or emotional stress.
- Wolff-Parkinson-White (WPW) Syndrome: A condition involving an abnormal electrical pathway in the heart, which can lead to rapid heart rates and potentially syncope.
- Mitral Valve Prolapse: While often asymptomatic, in some cases, it can lead to chest pain and, less commonly, to arrhythmias that might cause syncope.
Do Not Miss (ddxs that may not be likely, but would be deadly if missed):
- Aortic Dissection: Although rare in teenagers, an aortic dissection can present with severe, tearing chest pain and syncope. It's a medical emergency that requires immediate attention.
- Pulmonary Embolism: Uncommon in healthy teenagers but can occur, especially if there are underlying conditions such as a hypercoagulable state. Symptoms can include chest pain and syncope.
- Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC): A rare heart condition where the muscle in the right ventricle is replaced by fat and scar tissue, potentially leading to life-threatening arrhythmias and syncope.
Rare diagnoses:
- Marfan Syndrome: A genetic disorder that affects the body's connective tissue, which can lead to problems in various systems, including the cardiovascular system. It might cause chest pain and syncope due to aortic root dilatation or dissection.
- Ehlers-Danlos Syndrome: Another genetic disorder affecting connective tissues, which can have cardiovascular manifestations, including a risk of aortic dissection.
- Catecholaminergic Polymorphic Ventricular Tachycardia (CPVT): A rare genetic disorder that can cause life-threatening arrhythmias during physical activity or emotional stress, leading to syncope.
Each of these diagnoses requires careful consideration and further investigation, including a thorough medical history, physical examination, electrocardiogram (ECG), echocardiogram, and potentially other tests like a Holter monitor or genetic testing, depending on the suspected underlying condition.