Differential Diagnosis for Central, Sharp, Non-Radiating Chest Pain
Single Most Likely Diagnosis
- Hyperventilation syndrome or anxiety-related chest pain: This condition is often triggered by exertion or stress, leading to sharp, central chest pain and can be associated with brief syncope due to vasovagal response. The normal vitals, lactate, blood glucose level (BGL), and 12-lead electrocardiogram (ECG) support this diagnosis, as these tests would not typically be abnormal in anxiety-related conditions.
Other Likely Diagnoses
- Costochondritis: Inflammation of the cartilage that connects the ribs to the sternum, which can cause sharp, central chest pain that worsens with exertion or deep breathing. The brief syncope could be related to pain-induced hyperventilation or a vasovagal response.
- Musculoskeletal strain: Strain or injury to the muscles or ligaments in the chest wall can cause sharp pain, especially with exertion. While less likely to cause syncope, severe pain could potentially trigger a vasovagal response.
Do Not Miss Diagnoses
- Pulmonary embolism (PE): Although less likely given the sharp, non-radiating nature of the pain and the absence of other typical symptoms like dyspnea or tachycardia, PE can present atypically, especially in younger patients. The brief syncope could be a sign of a significant PE causing a drop in cardiac output.
- Aortic dissection: A life-threatening condition that can cause sudden, severe chest pain, which may be sharp and central. The absence of radiation or typical tearing sensation does not rule out this diagnosis. Brief syncope could occur due to involvement of the aortic root or severe pain-induced response.
- Cardiac arrhythmias: Certain arrhythmias, such as supraventricular tachycardia (SVT), can cause chest pain and syncope, especially if there is underlying cardiac disease. The normal 12-lead ECG does not entirely rule out intermittent arrhythmias.
Rare Diagnoses
- Pneumothorax: A spontaneous pneumothorax could cause sharp chest pain and, if large enough, could lead to syncope due to decreased cardiac output. However, this would typically be associated with shortness of breath and possibly abnormal vital signs.
- Pericarditis: Inflammation of the pericardium can cause sharp, central chest pain that may improve with sitting up and leaning forward. While it can cause syncope due to cardiac tamponade, this would typically be associated with other signs like a pericardial friction rub or specific ECG changes.