Differential Diagnosis

Given the sudden onset of symptoms, the differential diagnosis can be organized into the following categories:

• Single most likely diagnosis:
  • Acute Myocardial Infarction (AMI): This is often characterized by a sudden onset of chest pain, which can radiate to the arm, neck, or jaw, and is accompanied by shortness of breath, nausea, and sweating. The sudden nature of the event aligns with the typical presentation of an AMI.
• Other Likely diagnoses:
  • Pulmonary Embolism (PE): Sudden onset of shortness of breath, chest pain that worsens with deep breathing, and possibly coughing up blood. The sudden nature of symptoms can mimic other acute conditions.
  • Stroke or Transient Ischemic Attack (TIA): Sudden weakness, numbness, or paralysis of the face, arm, or leg, difficulty with speech or understanding, sudden blurred vision, or loss of vision in one eye. The sudden onset is a hallmark of these conditions.
  • Seizure: Characterized by a sudden loss of control over movements, which can range from slight twitching to violent convulsions, often accompanied by a loss of consciousness. The sudden onset fits the description.
• Do Not Miss diagnoses:
  • Aortic Dissection: Sudden, severe chest or back pain that can radiate to the arms or legs, often described as tearing. Missing this diagnosis can be fatal, and its sudden onset warrants consideration.
  • Pneumothorax: Sudden chest pain and shortness of breath, which can be life-threatening if not promptly treated. The sudden onset of symptoms makes it a critical diagnosis not to miss.
• Rare diagnoses:
  • Subarachnoid Hemorrhage: Sudden, severe headache often described as "the worst headache" of one's life, possibly accompanied by vomiting, confusion, and loss of consciousness. While less common, the sudden onset and severity of symptoms warrant its inclusion in the differential.
  • Takotsubo Cardiomyopathy: Characterized by sudden onset of chest pain, shortness of breath, and possibly fainting, often triggered by intense emotional or physical stress. It's less common but can mimic AMI in presentation.

Each of these diagnoses has a justification for inclusion based on the sudden onset of symptoms, with the likelihood and potential impact guiding their categorization.