Differential Diagnosis for a 35-year-old Man with Acute Chest Pain
Single Most Likely Diagnosis
- Acute Coronary Syndrome (ACS): Although the patient is relatively young, ACS, including myocardial infarction, is a leading cause of chest pain in adults and should always be considered, especially with acute onset. Risk factors such as family history, smoking, hypertension, and hyperlipidemia would increase the likelihood.
Other Likely Diagnoses
- Musculoskeletal Chest Pain: This is a common cause of chest pain, often related to strain or injury of the muscles or ribs. The absence of shortness of breath (SOB) or other systemic symptoms might lean towards this diagnosis.
- Gastroesophageal Reflux Disease (GERD): GERD can cause chest pain that may mimic cardiac pain, especially if it occurs after eating or at night. The lack of SOB or blurry vision does not rule out GERD.
- Pulmonary Embolism (PE): Although less likely without SOB, PE can present with chest pain and should be considered, especially if there are risk factors such as recent travel, immobility, or family history of clotting disorders.
Do Not Miss Diagnoses
- Aortic Dissection: A life-threatening condition that requires immediate intervention. Although it's less common in a 35-year-old without known risk factors like hypertension or connective tissue disorders, it's crucial not to miss due to its high mortality rate.
- Pneumothorax: Spontaneous pneumothorax can occur in tall, thin males and can present with sudden chest pain. It's critical to diagnose promptly as it can lead to respiratory distress if not treated.
- Pericarditis: Inflammation of the pericardium can cause chest pain that may be sharp and improve with leaning forward. It's essential to consider, especially if there's a recent viral illness or other inflammatory conditions.
Rare Diagnoses
- Esophageal Rupture: A rare but serious condition that can cause severe chest pain, often associated with vomiting or eating disorders.
- Spontaneous Coronary Artery Dissection (SCAD): A rare cause of ACS, more common in women but can occur in men, often without traditional risk factors.
- Chest Pain due to Pneumonia: Although less common without respiratory symptoms, pneumonia can cause chest pain, especially if it involves the pleura.