Differential Diagnosis for Chest Discomfort, Nausea, and Lightheadedness
Single Most Likely Diagnosis
- Acute Coronary Syndrome (ACS): This includes conditions such as myocardial infarction (heart attack) and unstable angina. The combination of chest discomfort, nausea, and lightheadedness is highly suggestive of ACS, especially in individuals with risk factors for coronary artery disease. The chest discomfort is often described as a pressure or heaviness, and the nausea and lightheadedness can occur due to decreased cardiac output or stress response.
Other Likely Diagnoses
- Gastroesophageal Reflux Disease (GERD): GERD can cause chest discomfort that may be mistaken for cardiac issues. Nausea can also be present, and while lightheadedness is less common, it can occur, especially if the discomfort is severe enough to cause anxiety or panic.
- Panic Attack: Panic attacks can cause chest discomfort, nausea, and lightheadedness due to hyperventilation and anxiety. The symptoms can be very similar to those of cardiac issues, making diagnosis challenging without a thorough history and examination.
- Pulmonary Embolism: While less common than ACS, pulmonary embolism can cause sudden onset of chest discomfort, nausea, and lightheadedness, especially if the embolism is large and causes significant obstruction to blood flow.
Do Not Miss Diagnoses
- Aortic Dissection: A tear in the aorta can cause severe, tearing chest pain, nausea, and lightheadedness. This condition is life-threatening and requires immediate diagnosis and treatment.
- Cardiac Tamponade: Fluid accumulation in the pericardial sac can compress the heart, leading to decreased cardiac output, which may cause chest discomfort, nausea, and lightheadedness. This condition is an emergency.
- Pneumothorax: A collapsed lung can cause sudden chest discomfort and shortness of breath, potentially leading to nausea and lightheadedness if not promptly treated.
Rare Diagnoses
- Esophageal Rupture: A tear in the esophagus can cause severe chest pain, nausea, and potentially lightheadedness due to pain and possible infection.
- Pericarditis: Inflammation of the pericardium can cause chest pain that may be accompanied by nausea and, less commonly, lightheadedness.
- Mitral Valve Prolapse: While often asymptomatic, in some cases, mitral valve prolapse can lead to chest discomfort, nausea, and lightheadedness, particularly if there is significant mitral regurgitation or arrhythmias.