Differential Diagnosis for 22-year-old Male with Anterior Chest Pain
- Single most likely diagnosis:
- Musculoskeletal strain: The patient's symptoms of anterior chest pain that developed while lifting weights, described as a burning sensation, are consistent with a musculoskeletal strain. The absence of radiation and the normal EKG further support this diagnosis.
- Other Likely diagnoses:
- Gastroesophageal reflux disease (GERD): The burning sensation of the chest pain and the initial report of nausea could suggest GERD, especially considering the consumption of an energy drink, which can irritate the esophagus.
- Costochondritis: This condition, characterized by inflammation of the cartilage that connects the ribs to the breastbone, could explain the chest discomfort, especially if it worsened with the physical activity of lifting weights.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.):
- Acute coronary syndrome (ACS): Although the patient is young and has no family history of cardiac disease, ACS cannot be entirely ruled out without further evaluation, including cardiac biomarkers, given the presentation of chest pain and shortness of breath.
- Pulmonary embolism (PE): The symptoms of shortness of breath and chest pain, even without radiation, could suggest a PE, which is a medical emergency. The lack of obvious risk factors does not exclude this diagnosis.
- Aortic dissection: This is a rare but life-threatening condition that could present with sudden onset of chest pain, often described as tearing or ripping. The absence of radiation and a normal EKG does not rule out this diagnosis.
- Rare diagnoses:
- Spontaneous pneumothorax: Although less common in this demographic without underlying lung disease, it could explain the sudden onset of chest pain and shortness of breath.
- Pericarditis: Inflammation of the pericardium could cause chest pain that might be described as sharp or burning, and the EKG finding of biatrial enlargement could be relevant, although pericarditis typically shows specific EKG changes not mentioned here.