What is the diagnosis for a 71-year-old male with a history of open heart surgery, presenting with sharp chest pain and atrial fibrillation (Afib) with a heart rate ranging from bradycardia to normal sinus rhythm?

Differential Diagnosis for 71 yo male with sharp chest pain and Afib

• Single most likely diagnosis

  • Pericarditis: The patient's history of open heart surgery and sharp chest pain are consistent with pericarditis, which is an inflammation of the pericardium that can occur after cardiac surgery. The pain is often sharp and can radiate to the trapezius ridge. The patient's Afib with heart rate variability may also be related to pericarditis.

• Other Likely diagnoses

  • Myocardial infarction (MI): Although the patient's heart rate is variable, MI should still be considered, especially given the patient's history of open heart surgery and sharp chest pain.
  • Pneumothorax: The sharp chest pain could be indicative of a pneumothorax, which can occur in patients with a history of recent surgery or underlying lung disease.
  • Pulmonary embolism (PE): PE can cause sharp chest pain and is a concern in patients with Afib, as they are at increased risk for thromboembolic events.

• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)

  • Aortic dissection: Although less likely, aortic dissection is a life-threatening condition that can cause sharp chest pain and should be considered, especially in patients with a history of open heart surgery.
  • Cardiac tamponade: Cardiac tamponade is a life-threatening condition that can occur after cardiac surgery and can cause sharp chest pain, hypotension, and pulsus paradoxus.
  • Esophageal rupture: Esophageal rupture is a rare but life-threatening condition that can cause sharp chest pain and should be considered in patients with a history of recent surgery or underlying esophageal disease.

• Rare diagnoses

  • Spontaneous coronary artery dissection (SCAD): SCAD is a rare condition that can cause myocardial infarction and sharp chest pain, but it is less likely in this patient given the history of open heart surgery.
  • Coronary artery spasm: Coronary artery spasm is a rare condition that can cause sharp chest pain, but it is less likely in this patient given the history of Afib and open heart surgery.