Differential Diagnosis for Uncontrolled Hypertension with Chest Pain
- Single most likely diagnosis
- Hypertensive heart disease with coronary artery disease: This is the most likely diagnosis because uncontrolled hypertension is a significant risk factor for the development of coronary artery disease, which can cause chest pain.
- Other Likely diagnoses
- Acute coronary syndrome (ACS): Uncontrolled hypertension increases the risk of ACS, which includes conditions such as myocardial infarction (MI) and unstable angina, all of which can present with chest pain.
- Hypertensive emergency with cardiac involvement: Severe uncontrolled hypertension can lead to cardiac complications such as heart failure or acute coronary syndrome, presenting with chest pain.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Aortic dissection: Although less common, aortic dissection is a life-threatening condition that can be associated with uncontrolled hypertension and chest pain. Missing this diagnosis could be fatal.
- Pulmonary embolism: While not directly related to hypertension, pulmonary embolism can cause chest pain and is a condition that should not be missed due to its high mortality rate if untreated.
- Cardiac tamponade: This is a life-threatening condition that can cause chest pain and is associated with various etiologies, including hypertension. It requires immediate recognition and treatment.
- Rare diagnoses
- Pheochromocytoma: A rare tumor of the adrenal gland that can cause episodic or sustained hypertension and may lead to chest pain due to cardiac involvement or other mechanisms.
- Takotsubo cardiomyopathy: Also known as "stress cardiomyopathy," this condition can mimic acute coronary syndrome and is associated with intense emotional or physical stress, which could be related to uncontrolled hypertension.
- Aortic stenosis: While not directly caused by hypertension, severe aortic stenosis can lead to chest pain and is exacerbated by uncontrolled hypertension. It's less common but important to consider in the differential diagnosis.