Differential Diagnosis

Given the patient's resolution of symptoms and mildly elevated troponins, the differential diagnosis can be organized as follows:

• Single most likely diagnosis:
  • Acute Coronary Syndrome (ACS) - The mildly elevated troponins are a strong indicator of myocardial injury, which is a hallmark of ACS. The resolution of symptoms could be due to spontaneous resolution or early treatment.
• Other Likely diagnoses:
  • Musculoskeletal chest pain - Although the patient's symptoms have resolved, musculoskeletal issues can cause chest pain that mimics more serious conditions. The absence of ongoing symptoms makes this more plausible.
  • Pulmonary embolism (resolved) - While less likely given the resolution of symptoms and the lack of specific pulmonary findings, a small, resolved pulmonary embolism could potentially cause transient symptoms and mildly elevated troponins due to right heart strain.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.):
  • Vertebral artery dissection - Although the patient's symptoms have resolved, vertebral artery dissection can have a delayed presentation or fluctuating course. It's crucial to consider this diagnosis due to its potential for severe neurological consequences, including stroke.
  • Aortic dissection - This is a medical emergency that requires immediate attention. Even though the symptoms have resolved, a type A dissection could have a variable presentation, and missing this diagnosis could be fatal.
  • Cardiac tamponade - The mildly elevated troponins could be indicative of myocardial injury, and cardiac tamponade is a life-threatening condition that can present with chest pain and could potentially resolve if the tamponade effect is transient or if there has been some intervention.
• Rare diagnoses:
  • Spontaneous coronary artery dissection (SCAD) - A rare cause of ACS, more common in women without traditional cardiovascular risk factors. The resolution of symptoms does not rule out SCAD, as it can have a variable presentation.
  • Myopericarditis - Inflammation of the myocardium and pericardium can cause chest pain and elevated troponins. It's less likely given the initial presentation but could be considered, especially if there are other systemic symptoms or if the patient has been exposed to certain viruses or drugs.