Differential Diagnosis for Chest Pain Radiating to the Left Arm

The patient's presentation of chest pain radiating to the left arm, accompanied by sweating and shortness of breath, suggests a cardiovascular origin. Here's a categorized differential diagnosis:

• Single Most Likely Diagnosis

  • Acute Myocardial Infarction (MI): The classic presentation of chest pain radiating to the left arm, sweating, and shortness of breath is highly suggestive of an acute MI, commonly known as a heart attack. This condition occurs when the blood flow to the heart is blocked, causing damage to the heart muscle.

• Other Likely Diagnoses

  • Angina Pectoris: This condition is characterized by chest pain or discomfort due to transient myocardial ischemia. It's often precipitated by exertion or emotional stress and relieved by rest or nitroglycerin.
  • Acute Coronary Syndrome (ACS): This encompasses a range of conditions associated with sudden loss of blood flow to the heart, including unstable angina and non-ST elevation MI, in addition to ST-elevation MI.
  • Pulmonary Embolism (PE): While less common, PE can present with chest pain and shortness of breath. The pain can be sharp and stabbing, and it may worsen with deep breathing.

• Do Not Miss Diagnoses

  • Aortic Dissection: A life-threatening condition where there is a tear in the inner layer of the aorta. It can present with severe, tearing chest pain that radiates to the back or arms.
  • Pneumothorax: Air in the pleural space can cause chest pain and shortness of breath. A tension pneumothorax is particularly dangerous and requires immediate intervention.
  • Esophageal Rupture: Although rare, it can mimic cardiac conditions with severe chest pain and is a medical emergency.

• Rare Diagnoses

  • Pericarditis: Inflammation of the pericardium, the sac surrounding the heart, can cause chest pain that may improve with leaning forward.
  • Myocarditis: Inflammation of the heart muscle itself, which can present with chest pain, among other symptoms like fever and palpitations.
  • Chest Wall Syndromes: Conditions like costochondritis or Tietze's syndrome can cause chest pain but typically do not radiate and are not associated with the systemic symptoms like sweating and shortness of breath.

Initial Management Steps

• Assess Airway, Breathing, and Circulation (ABCs): Ensure the patient's airway is patent, breathing is adequate, and circulation is sufficient.
• Electrocardiogram (ECG): Immediately perform an ECG to evaluate for signs of ischemia or infarction.
• Oxygen and Monitoring: Provide supplemental oxygen if necessary and monitor vital signs closely.
• Aspirin Administration: Administer aspirin promptly if there's suspicion of acute coronary syndrome, provided there are no contraindications.
• Activate Emergency Services: If the diagnosis of a life-threatening condition like acute MI or aortic dissection is suspected, activate emergency services for rapid transport to a hospital capable of providing definitive care, such as percutaneous coronary intervention (PCI) for acute MI.