Differential Diagnosis

The patient's symptoms of chest pressure, shortness of breath, heart palpitations, and metallic taste in the mouth can be attributed to various conditions. Here's a categorized differential diagnosis:

• Single Most Likely Diagnosis

  • Acute Coronary Syndrome (ACS): The combination of chest pressure and shortness of breath, along with heart palpitations, strongly suggests a cardiac origin, with ACS being a leading consideration due to its potential to cause these symptoms directly.

• Other Likely Diagnoses

  • Anxiety or Panic Disorder: These conditions can cause chest discomfort, shortness of breath, and palpitations, and the metallic taste could be associated with anxiety-induced hyperventilation or as a symptom of an associated condition.
  • Gastroesophageal Reflux Disease (GERD): GERD can cause chest pressure and discomfort that may be mistaken for cardiac issues, and while less likely to cause a metallic taste directly, it could contribute to discomfort that exacerbates anxiety or other symptoms.
  • Pulmonary Embolism: Although less common, this condition can cause sudden onset of shortness of breath and chest pain, and while the metallic taste is not typical, it should be considered due to its severity.

• Do Not Miss Diagnoses

  • Myocardial Infarction (MI): A critical condition that could present with the described symptoms, especially the chest pressure and shortness of breath. Missing this diagnosis could be fatal.
  • Pulmonary Embolism: As mentioned, this is a potentially life-threatening condition that requires immediate attention.
  • Aortic Dissection: Although rare, this condition presents with severe chest pain and could lead to heart palpitations and shortness of breath. Its diagnosis is critical due to the high mortality rate if untreated.
  • Cardiac Tamponade: A condition where fluid accumulates in the sac around the heart, leading to impaired heart function. It can cause chest pain, shortness of breath, and palpitations, and is life-threatening if not promptly treated.

• Rare Diagnoses

  • Heavy Metal Poisoning: Certain heavy metals can cause a metallic taste, and some, like lead or arsenic, can affect the cardiovascular system, potentially leading to palpitations or chest discomfort.
  • Mitral Valve Prolapse: A condition that can cause chest discomfort, palpitations, and shortness of breath, though it's less likely to cause a metallic taste.
  • Hypokalemia or Hyperkalemia: Electrolyte imbalances can lead to cardiac arrhythmias and muscle weakness, potentially causing some of the described symptoms, including palpitations and shortness of breath, though the metallic taste would be an unusual presentation.