Differential Diagnosis for Exertional Chest Pain
- The patient's symptoms of exertional chest pain radiating to the left arm and dyspnea daily for 1 month are concerning for several diagnoses.
Single Most Likely Diagnosis
- Coronary Artery Disease (CAD): This is the most likely diagnosis given the patient's age, exertional nature of the chest pain, and radiation to the left arm. CAD is a common cause of chest pain in adults, especially in those over 45 years old.
Other Likely Diagnoses
- Hypertension: Uncontrolled hypertension can cause exertional chest pain and dyspnea, especially in African American patients who are at higher risk for developing hypertension.
- Asthma or Chronic Obstructive Pulmonary Disease (COPBO): These conditions can cause dyspnea and chest tightness, especially with exertion.
- Gastroesophageal Reflux Disease (GERD): GERD can cause chest pain that radiates to the arm, although it is less likely to be exertional.
Do Not Miss Diagnoses
- Pulmonary Embolism (PE): Although less likely, PE is a life-threatening condition that can cause exertional chest pain and dyspnea. It is essential to consider PE in the differential diagnosis, especially if the patient has risk factors such as recent travel or family history.
- Aortic Dissection: This is a rare but life-threatening condition that can cause severe, tearing chest pain that radiates to the arm. It is essential to consider aortic dissection in the differential diagnosis, especially if the patient has a history of hypertension or aortic aneurysm.
- Myocardial Infarction (MI): An MI can cause exertional chest pain and dyspnea, and it is essential to consider this diagnosis, especially if the patient has risk factors such as hypertension, diabetes, or family history of CAD.
Rare Diagnoses
- Pericarditis: This is an inflammation of the pericardium that can cause chest pain that radiates to the arm. It is less likely to be exertional and is often associated with a pericardial friction rub.
- Pneumotharmothorax: This is a rare condition that can cause chest pain and dyspnea, especially if the patient has a history of lung disease or recent trauma.