Differential Diagnosis for Intermittent Chest Pain with T Wave Inversions and Normal Cardiac Markers
- Single Most Likely Diagnosis
- Anxiety or Stress-Related Chest Pain: This is often seen in patients with anxiety disorders or those under significant stress, leading to intermittent chest pain and T wave inversions on EKG due to hyperventilation or stress-induced changes.
- Other Likely Diagnoses
- Chest Wall Pain (Costochondritis): Inflammation of the cartilage that connects the ribs to the breastbone can cause sharp pains, especially with movement or deep breathing, and may lead to T wave changes due to muscle strain.
- Gastroesophageal Reflux Disease (GERD): Stomach acid flowing back into the esophagus can cause chest pain, which may be intermittent and can sometimes lead to EKG changes due to esophageal spasm.
- Pulmonary Embolism (Small or Peripheral): Although less likely with normal cardiac markers, a small pulmonary embolism could cause intermittent chest pain and T wave inversions, especially if the embolism is peripheral and not causing significant cardiac strain.
- Do Not Miss Diagnoses
- Acute Coronary Syndrome (ACS) with Normal Cardiac Markers: Early in the course of a myocardial infarction, cardiac markers may not be elevated, and T wave inversions can be an early sign. It's crucial to monitor the patient closely and possibly repeat cardiac markers.
- Aortic Dissection: Although typically presenting with severe, tearing chest pain, an aortic dissection can sometimes cause intermittent pain and must be considered due to its high mortality rate if missed.
- Pulmonary Hypertension: Can cause chest pain due to right ventricular strain and may show T wave inversions in the anterior leads due to right ventricular hypertrophy.
- Rare Diagnoses
- Pericarditis: Inflammation of the pericardium can cause chest pain and EKG changes, including T wave inversions, but typically presents with a more characteristic pericarditic pattern (widespread ST elevation).
- Hypertrophic Cardiomyopathy: A condition where the heart muscle becomes thickened, which can lead to chest pain and T wave inversions on EKG, especially in younger patients.
- Mitral Valve Prolapse: Can cause chest pain and may show T wave inversions, particularly if there is associated mitral regurgitation or other cardiac abnormalities.