Differential Diagnosis for Severe Neck, Chest Pain, and Shortness of Breath
Single Most Likely Diagnosis
- Acute Coronary Syndrome (ACS) with Non-ST Elevation Myocardial Infarction (NSTEMI) or ST-Elevation Myocardial Infarction (STEMI): Despite negative troponins, which may be seen early in the course of myocardial infarction, the presence of ST elevation on EKG is highly suggestive of STEMI, a type of ACS. The symptoms of severe chest pain and shortness of breath further support this diagnosis.
Other Likely Diagnoses
- Pulmonary Embolism (PE): The combination of chest pain, shortness of breath, and a slightly elevated white count could suggest a pulmonary embolism, especially if the patient has risk factors such as recent immobilization, cancer, or a history of deep vein thrombosis.
- Pneumonia: Although the primary symptoms are chest and neck pain, pneumonia could cause these symptoms, especially if the pneumonia is severe or if there is involvement of the pleura (pleurisy). The slightly elevated white count supports an infectious or inflammatory process.
- Aortic Dissection: This condition, characterized by a tear in the aorta's inner layer, can cause severe, tearing chest pain that may radiate to the neck and is associated with shortness of breath. It's a critical diagnosis to consider, given the severity of symptoms.
Do Not Miss Diagnoses
- Pulmonary Embolism: Repeated here because, despite being in "Other Likely Diagnoses," it's crucial not to miss due to its high mortality rate if untreated.
- Aortic Dissection: Also repeated as it is critical not to miss due to its high mortality rate and the need for immediate surgical intervention.
- Esophageal Rupture: Although less common, esophageal rupture can cause severe chest pain and shortness of breath, especially if there is associated mediastinitis. It's a diagnosis that could be deadly if missed.
Rare Diagnoses
- Spontaneous Coronary Artery Dissection (SCAD): A rare cause of acute coronary syndrome, more common in women and without the typical risk factors for coronary artery disease.
- Takotsubo Cardiomyopathy: Also known as "stress cardiomyopathy," it can mimic acute coronary syndrome with chest pain, shortness of breath, and EKG changes, but it is caused by extreme emotional or physical stress.
- Acute Pericarditis: Inflammation of the pericardium can cause chest pain that may improve with leaning forward and worsen with lying down, and it can be associated with a pericardial friction rub. EKG changes, including ST elevation, can occur but are typically more diffuse than in STEMI.