Differential Diagnosis for Severe Chest Pain with ST Segment Elevation in Leads V1 through V4 and Associated Q Wave Deployment
- Single Most Likely Diagnosis
- Acute Anterior Myocardial Infarction (MI): This is the most likely diagnosis given the presentation of severe chest pain, ST segment elevation in leads V1 through V4, and associated Q wave deployment, which are all characteristic findings of an acute anterior MI.
- Other Likely Diagnoses
- Acute Pericarditis: Although less likely than MI, acute pericarditis can present with chest pain and ST segment elevation. However, the ST segment elevation in pericarditis is typically more diffuse and not limited to the anterior leads.
- Pulmonary Embolism (PE): A large PE can cause acute chest pain and electrocardiographic changes, including ST segment elevation, although this is less common.
- Do Not Miss Diagnoses
- Aortic Dissection: Although less common, aortic dissection is a life-threatening condition that can present with severe chest pain and can sometimes cause ST segment elevation if the dissection involves the coronary arteries.
- Cardiac Tamponade: This is another life-threatening condition that can cause chest pain and electrocardiographic abnormalities, including low voltage QRS or electrical alternans, but ST segment elevation can occasionally be seen.
- Rare Diagnoses
- Myocardial Bridging: A rare condition where a portion of a coronary artery dives into and is surrounded by myocardium, which can cause chest pain and ST segment elevation during periods of increased demand.
- Tako-Tsubo Cardiomyopathy (Stress Cardiomyopathy): A condition that mimics acute MI with chest pain and ST segment elevation but is caused by extreme emotional or physical stress leading to transient left ventricular dysfunction.
- Coronary Artery Spasm: Also known as variant angina, this condition can cause chest pain and ST segment elevation due to transient coronary artery spasm, but it is less likely to cause Q wave deployment.