Differential Diagnosis for Periodic Chest Pain and Tachycardia in a Patient with COVID-19 or Influenza

Single Most Likely Diagnosis

• Acute Coronary Syndrome (ACS): Given the symptoms of periodic chest pain and tachycardia, especially in the context of a viral infection like COVID-19 or influenza, which can increase the risk of thrombotic events, ACS is a highly plausible diagnosis. The stress of the infection can exacerbate cardiac conditions.

Other Likely Diagnoses

• Pulmonary Embolism (PE): Both COVID-19 and influenza can lead to an increased risk of venous thromboembolism, including PE, which presents with chest pain and tachycardia. The periodic nature of the pain could be related to the movement of the clot or changes in respiratory status.
• Myocarditis: Direct viral infection of the heart muscle can cause myocarditis, leading to chest pain and arrhythmias, including tachycardia. Both COVID-19 and influenza have been associated with myocarditis.
• Pneumonia: Severe pneumonia, especially if caused by influenza or a secondary bacterial infection in the setting of COVID-19, can cause chest pain and tachycardia due to inflammation of the lung tissue and the pleura.

Do Not Miss Diagnoses

• Pulmonary Hypertension Crisis: Although less common, a crisis in pulmonary hypertension can present with sudden onset of chest pain and tachycardia. Given the potential for severe outcomes, it's crucial not to miss this diagnosis.
• Aortic Dissection: This is a life-threatening condition that requires immediate intervention. Chest pain and tachycardia can be presenting symptoms, and while it's less likely, the consequences of missing this diagnosis are severe.
• Cardiac Tamponade: Accumulation of fluid in the pericardial space can compress the heart, leading to chest pain, tachycardia, and potentially life-threatening complications if not promptly addressed.

Rare Diagnoses

• Spontaneous Pneumothorax: Although more common in certain populations (e.g., tall, thin males), a spontaneous pneumothorax can occur and present with sudden chest pain and tachycardia. It's less likely but should be considered, especially if there's a significant respiratory component to the presentation.
• Pericarditis: Inflammation of the pericardium can cause chest pain that may improve with leaning forward and worsen with lying down or deep breathing. While it can be associated with viral infections, it's less common than other diagnoses listed here.