Differential Diagnosis for Central Chest Pain
- Single most likely diagnosis
- Acute Pericarditis: The patient's symptoms of central chest pain that worsens with inspiration and leaning forward, and improves with sitting up and leaning forward, are classic for pericarditis. The improvement in pain with aspirin also supports this diagnosis, as aspirin is often used to treat pericarditis.
- Other Likely diagnoses
- Acute Coronary Syndrome (ACS): Although the patient is relatively young and has no past medical history, ACS is still a possible diagnosis, especially given the central chest pain and the improvement with aspirin. However, the worsening of pain with inspiration and leaning forward is less typical for ACS.
- Pulmonary Embolism (PE): The patient's symptoms of sudden onset chest pain and tachycardia could be consistent with a PE, although the lack of cough, calf pain, or recent travel makes this diagnosis less likely.
- Pneumonia: The patient's mild fever and tachycardia could suggest an infectious etiology such as pneumonia, although the lack of cough or cordial symptoms makes this diagnosis less likely.
- Do Not Miss diagnoses
- Aortic Dissection: Although the patient's symptoms are not typical for aortic dissection (e.g., no tearing or radiating pain), this diagnosis is potentially life-threatening and should not be missed. The patient's tachycardia and central chest pain warrant consideration of this diagnosis.
- Pulmonary Embolism (PE) with atypical presentation: As mentioned earlier, PE is a possible diagnosis, and although the patient's presentation is atypical, it is crucial to consider this diagnosis due to its high mortality rate if missed.
- Rare diagnoses
- Esophageal rupture or perforation: The patient's central chest pain and worsening with inspiration could be consistent with an esophageal rupture or perforation, although this diagnosis is rare and would typically be associated with other symptoms such as severe epigastric pain or vomiting.
- Spontaneous coronary artery dissection (SCAD): This is a rare cause of ACS, particularly in young women with no past medical history. Although the patient's symptoms are not typical for SCAD, it is essential to consider this diagnosis due to its potential for severe consequences if missed.