Differential Diagnosis for Chest Pain and Hypertension

The following differential diagnosis is organized into categories to help guide the thought process:

• Single Most Likely Diagnosis
  • Hypertensive cardiovascular disease: This is the most likely diagnosis given the combination of chest pain and hypertension. The chest pain could be related to coronary artery disease, myocardial infarction, or other cardiac conditions exacerbated by high blood pressure.
• Other Likely Diagnoses
  • Acute coronary syndrome (ACS): This includes conditions such as myocardial infarction (MI) and unstable angina, which are common causes of chest pain and can be associated with hypertension.
  • Pulmonary embolism: Although less common, pulmonary embolism can cause chest pain and may be associated with hypertension due to the stress response.
  • Aortic dissection: This is a serious condition where there is a tear in the aorta's inner layer, which can cause severe chest pain and is often associated with hypertension.
• Do Not Miss Diagnoses
  • Myocardial infarction (MI): Especially an MI involving the right ventricle or with a non-ST elevation pattern, which might not present with the typical ECG changes but is crucial to diagnose promptly.
  • Aortic dissection: As mentioned, this condition requires immediate diagnosis and treatment to prevent fatal outcomes.
  • Pulmonary embolism with hemodynamic instability: Early recognition and treatment are critical to prevent high mortality.
  • Cardiac tamponade: Although rare, it can present with chest pain and hypertension due to the body's compensatory mechanisms and is a medical emergency.
• Rare Diagnoses
  • Hypertrophic cardiomyopathy: A condition where the heart muscle becomes abnormally thick, which can lead to chest pain and is associated with hypertension in some cases.
  • Pericarditis: Inflammation of the pericardium, the sac surrounding the heart, can cause chest pain and may be associated with hypertension due to the inflammatory response.
  • Pheochromocytoma: A rare tumor of the adrenal gland that can cause episodic hypertension and chest pain due to catecholamine release.

Each of these diagnoses has a brief justification based on the presenting symptoms of chest pain and hypertension, emphasizing the importance of considering both common and rare conditions to ensure accurate diagnosis and appropriate management.