Differential Diagnosis for Anterior Chest Wall Pain

The patient's symptoms of anterior chest wall pain, increased heart rate, palpitations, and nausea warrant a thorough evaluation. The following differential diagnosis is organized into categories:

• Single Most Likely Diagnosis

  • Costochondritis: This condition is characterized by inflammation of the cartilage that connects the ribs to the sternum, which can cause chest pain, particularly in the anterior chest wall. The patient's symptoms of intermittent pain, increased heart rate, and palpitations, which are short-lived, are consistent with costochondritis. The fact that the patient is physically active, working out 6 days a week, may contribute to the development of costochondritis.

• Other Likely Diagnoses

  • Precordial Catch Syndrome: This condition is a common cause of chest pain in young adults, characterized by sharp, stabbing pain in the precordial region. The pain can be accompanied by increased heart rate and palpitations.
  • Musculoskeletal Strain: The patient's intense workout routine may lead to musculoskeletal strain, causing chest wall pain.
  • Gastroesophageal Reflux Disease (GERD): Although the patient denies association with food, GERD can cause chest pain and nausea, and should be considered in the differential diagnosis.

• Do Not Miss Diagnoses

  • Acute Coronary Syndrome (ACS): Although the patient is young and physically active, ACS is a life-threatening condition that must be ruled out. The presence of chest pain, increased heart rate, and palpitations warrants an evaluation for ACS.
  • Pulmonary Embolism (PE): PE is a potentially life-threatening condition that can cause chest pain, increased heart rate, and nausea. Although the patient's symptoms are intermittent and short-lived, PE must be considered in the differential diagnosis.
  • Cardiac Arrhythmias: The patient's symptoms of palpitations and increased heart rate may indicate an underlying cardiac arrhythmia, which can be life-threatening if left untreated.

• Rare Diagnoses

  • Tietze's Syndrome: This is a rare condition characterized by inflammation of the cartilage that connects the ribs to the sternum, similar to costochondritis. However, Tietze's syndrome typically affects the upper ribs and can cause swelling.
  • Sickle Cell Crisis: Although rare, sickle cell crisis can cause chest pain, increased heart rate, and nausea, particularly in patients with sickle cell disease.
  • Hypertrophic Cardiomyopathy: This is a rare genetic disorder that can cause cardiac arrhythmias, increased heart rate, and chest pain, particularly in young adults.