Differential Diagnosis for Intermittent Chest Pain with T Wave Inversions and Normal Cardiac Markers
- Single Most Likely Diagnosis
- Unstable Angina: This is a likely diagnosis given the patient's symptoms of intermittent chest pain and EKG changes (T wave inversions) without elevated cardiac markers. Unstable angina is a condition where the heart doesn't get enough blood flow and oxygen, often due to coronary artery disease, but without the permanent damage seen in a myocardial infarction.
- Other Likely Diagnoses
- Myocardial Bridging: This condition involves a portion of a coronary artery being compressed by a bridge of heart muscle, leading to intermittent ischemia and chest pain. It could present with similar EKG changes and normal cardiac markers.
- Coronary Artery Spasm (Prinzmetal’s Angina): This condition involves sudden spasms of the coronary arteries, which can cause chest pain and EKG changes similar to those seen in unstable angina, but often without elevated cardiac markers.
- Pericarditis: Inflammation of the pericardium can cause chest pain and EKG changes, including T wave inversions. However, the pain pattern and other symptoms (such as positional pain) might differ.
- Do Not Miss Diagnoses
- Pulmonary Embolism: Although less likely, pulmonary embolism can present with chest pain and T wave inversions on the EKG. It's crucial to consider this diagnosis due to its high mortality rate if untreated.
- Aortic Dissection: This is a life-threatening condition where there is a tear in the aorta's inner layer. It can present with chest pain and might show nonspecific EKG changes, including T wave inversions. Immediate diagnosis and treatment are critical.
- Rare Diagnoses
- Apical Hypertrophic Cardiomyopathy: A rare form of hypertrophic cardiomyopathy that can cause chest pain and EKG abnormalities, including T wave inversions, due to the abnormal thickening of the heart muscle.
- Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC): A rare heart condition where the muscle in the right ventricle is replaced by fat and scar tissue, potentially leading to abnormal heart rhythms and chest pain. EKG changes might include T wave inversions in the right precordial leads.