Differential Diagnosis for 35-year-old Female with Electric Shock, Difficulty Moving Limbs, ECG Showing RBBB with ST Depression, and Normal Neuro Examination

• Single Most Likely Diagnosis
  • Acute Coronary Syndrome (ACS): The presentation of electric shock-like chest pain, difficulty moving limbs (possibly due to pain or associated anxiety), ECG changes (RBBB with global ST depression), and normal neuro examination could suggest an acute coronary syndrome, particularly given the ECG findings which are indicative of myocardial ischemia or infarction.
• Other Likely Diagnoses
  • Pulmonary Embolism (PE): Although less common in younger individuals without clear risk factors, PE can present with sudden onset of chest pain and ECG changes, including RBBB and ST depression, due to the strain on the right heart.
  • Pericarditis: This condition can cause chest pain and ECG changes, including ST depression, but the global nature of the ST depression and the presence of RBBB might lean more towards myocardial involvement.
• Do Not Miss Diagnoses
  • Aortic Dissection: A life-threatening condition that can present with sudden, severe chest pain (often described as tearing or ripping) and can lead to limb ischemia if the dissection involves the aortic branches. ECG changes can occur if the dissection involves the coronary arteries.
  • Cardiac Tamponade: Although the presentation might not fully align, cardiac tamponade can cause chest pain, ECG changes, and can lead to decreased cardiac output, potentially causing limb symptoms due to decreased perfusion.
• Rare Diagnoses
  • Hypertrophic Cardiomyopathy (HCM): While HCM can cause chest pain and ECG abnormalities, the acute presentation with RBBB and global ST depression would be unusual.
  • Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC): This condition can lead to arrhythmias and might present with ECG abnormalities, but the specific findings in this case are not typical for ARVC.
  • Takotsubo Cardiomyopathy: Also known as "stress cardiomyopathy," this condition can mimic ACS with ECG changes and chest pain but is often precipitated by intense emotional or physical stress. The ECG findings can include ST depression and the condition can lead to transient left ventricular dysfunction.