Differential Diagnosis for Substernal Chest Pain Radiating to the Right Shoulder
- Single Most Likely Diagnosis
- Myocardial Infarction (MI): This is often the first consideration for substernal chest pain, especially when it radiates to the shoulder. The pain is typically described as a pressure or heaviness and can be associated with other symptoms like shortness of breath, nausea, or diaphoresis.
- Other Likely Diagnoses
- Gastroesophageal Reflux Disease (GERD): GERD can cause substernal chest pain that may radiate to the shoulder, often worsened by lying down or eating certain foods. The pain can be burning in nature and may be accompanied by regurgitation or dysphagia.
- Peptic Ulcer Disease: Similar to GERD, peptic ulcers can cause epigastric or substernal pain that radiates to the shoulder, especially if the ulcer is located in the duodenum or stomach.
- Musculoskeletal Pain: Strains or inflammation of the muscles or joints in the chest wall or shoulder can cause pain that feels like it's coming from the substernal area and radiates to the shoulder.
- Do Not Miss Diagnoses
- Pulmonary Embolism (PE): Although less common, a pulmonary embolism can cause sudden onset of substernal chest pain that radiates to the shoulder, often accompanied by shortness of breath, tachypnea, or syncope. Missing this diagnosis can be fatal.
- Aortic Dissection: This is a life-threatening condition where the inner layer of the aorta tears, causing severe, tearing chest pain that can radiate to the back or shoulder. It's crucial to consider this diagnosis, especially in patients with risk factors like hypertension or aortic aneurysm.
- Esophageal Rupture: A rupture of the esophagus can cause severe, sudden-onset chest pain that may radiate to the shoulder, often accompanied by difficulty swallowing or vomiting. This condition requires immediate medical attention.
- Rare Diagnoses
- Pancreatitis: Inflammation of the pancreas can cause severe abdominal pain that may radiate to the back or shoulder, though it's less commonly associated with substernal chest pain.
- Cholecystitis: Inflammation of the gallbladder can cause right upper quadrant abdominal pain that may radiate to the right shoulder, though it's not typically associated with substernal chest pain.
- Pneumonia or Pleuritis: Certain infections or inflammatory conditions affecting the lungs or pleura can cause chest pain that radiates to the shoulder, though these are less common causes of substernal chest pain radiating to the shoulder.