Differential Diagnosis
- Single most likely diagnosis
- Myocardial infarction (MI): The patient's symptoms of severe left upper quadrant (LUQ) pain radiating to the back, shortness of breath, and exertional component are concerning for cardiac ischemia, especially given the recent history of cardioversion and use of Multaq, which can increase the risk of thromboembolic events.
- Other Likely diagnoses
- Pulmonary embolism (PE): The patient's symptoms of shortness of breath, chest pain, and recent history of cardioversion increase the risk of PE.
- Gastroesophageal reflux disease (GERD) or peptic ulcer disease: The patient's abdominal discomfort leading to the cessation of Multaq and subsequent LUQ pain could be related to gastrointestinal issues.
- Pericarditis: The sharp, intermittent pain and recent cardioversion procedure make pericarditis a possible diagnosis.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Aortic dissection: Although less likely, the severe, sharp pain radiating to the back and recent history of cardioversion necessitate consideration of this life-threatening condition.
- Esophageal rupture: The patient's severe LUQ pain and recent history of abdominal discomfort could be indicative of an esophageal rupture, which is a medical emergency.
- Rare diagnoses
- Pneumothorax: The patient's shortness of breath and chest pain could be related to a pneumothorax, although this is less likely given the lack of other symptoms such as cough or recent trauma.
- Pancreatitis: The patient's LUQ pain and recent abdominal discomfort could be related to pancreatitis, although this is less likely given the lack of other symptoms such as nausea or vomiting.