Differential Diagnosis for Chest Pain and Headache with Tachycardia

Given the symptoms of chest pain, headache, a heart rate of 170, and blood pressure of 100/80, the following differential diagnoses are considered:

• Single Most Likely Diagnosis

  • Supraventricular Tachycardia (SVT): This condition is characterized by an abnormally fast heart rate that originates above the ventricles. The symptoms of chest pain, headache, and significantly elevated heart rate are consistent with SVT, especially given the patient's tachycardia and relatively low blood pressure, which could indicate decreased cardiac output.

• Other Likely Diagnoses

  • Myocardial Infarction (MI): Although less likely given the patient's age is not specified and the blood pressure is not indicative of cardiogenic shock, MI should be considered, especially if the chest pain is described as squeezing, pressure, or heaviness.
  • Anxiety or Panic Attack: These conditions can present with tachycardia, chest pain, and headache due to hyperventilation and increased sympathetic activity.
  • Dehydration or Electrolyte Imbalance: Severe dehydration or electrolyte imbalances, such as hyperkalemia or hypokalemia, can lead to tachycardia and potentially chest pain or headache.

• Do Not Miss Diagnoses

  • Aortic Dissection: Although less common, aortic dissection is a life-threatening condition that can present with sudden, severe chest pain and tachycardia. The headache could be related to the pain radiating to the back or involvement of the aortic arch.
  • Pulmonary Embolism (PE): PE can cause tachycardia, chest pain (especially if pleuritic), and potentially headache due to hypoxia or anxiety. It's crucial to consider PE, especially if there are risk factors such as recent travel, immobilization, or family history of clotting disorders.
  • Cardiac Tamponade: This condition, characterized by fluid accumulation in the pericardial sac, can lead to tachycardia, decreased blood pressure, and potentially chest pain. It's a medical emergency requiring prompt diagnosis and treatment.

• Rare Diagnoses

  • Pheochromocytoma: A rare tumor of the adrenal gland that can cause episodic hypertension, tachycardia, headache, and chest pain due to excessive catecholamine release.
  • Thyroid Storm: A life-threatening condition in patients with untreated or undertreated hyperthyroidism, characterized by severe tachycardia, hypertension, and potentially chest pain or headache.
  • Cocaine-Induced Cardiomyopathy: Cocaine use can lead to myocardial infarction, arrhythmias, and cardiomyopathy, presenting with chest pain, tachycardia, and potentially headache.

Each of these diagnoses requires careful consideration of the patient's history, physical examination, and diagnostic tests such as ECG, troponin levels, and imaging studies to determine the underlying cause of the symptoms.