Medical Emergencies · patient case question
What is the most likely diagnosis?
Patient case: Chest pain in a patient with reflux and cardiac history
Patient: Adult with multiple medical problems
Chief complaint: Substernal pain radiating to the shoulder, beginning in the chair.
Background: Gastro-oesophageal reflux disease on medication. Hypertension. Known cardiac history and dyspepsia.
Vital signs / labs: Vital signs normal. No arrhythmia detected.
Current findings: Pain is substernal and radiates to the shoulder.
Show answer and explanation
Correct answer: B. Angina pectoris
- A. Reflux is a genuine differential given his history, and the distinction is clinically difficult — but radiation to the shoulder points to cardiac origin, and the safe assumption is cardiac.
- B. CORRECT. Substernal pain RADIATING TO THE SHOULDER is the classic description of cardiac ischaemia. Radiation to the left arm, shoulder, jaw or neck is what distinguishes angina from reflux, and given his known cardiac history this must be assumed cardiac until proved otherwise. Reflux may mimic it, but you cannot afford to make that assumption in the chair.
- C. A panic attack may cause chest tightness but would not be the working assumption in a patient with established cardiac disease.
- D. Syncope is transient loss of consciousness, which is not described.
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