A patient complains of chest pain radiating to both shoulders, is pale, diaphoretic, and slightly short of breath. What should you suspect?

The symptoms described, including chest pain that radiates to both shoulders, along with signs of pallor, diaphoresis (sweating), and slight shortness of breath, are highly suggestive of a myocardial infarction (MI).

In a myocardial infarction, the heart muscle is deprived of oxygen-rich blood, typically due to a blockage in one or more of the coronary arteries. The presentation of chest pain is classic, often described as squeezing, pressure, or tightness. Radiation of pain to the shoulders is also a common feature, as the heart shares nerve pathways with areas of the upper body, which can cause referred pain.

Pallor and diaphoresis are signs of significant stress on the body, indicating a sympathetic nervous system response to pain or a significant cardiac event. The slight shortness of breath further supports the likelihood of a myocardial infarction, as this can occur when the heart struggles to function adequately due to obstructed blood flow.

While other conditions like heartburn, pulmonary embolism, and aortic dissection could present with chest pain, the combination of symptoms in this scenario—especially the radiating pain, diaphoresis, and shortness of breath—most closely aligns with a myocardial infarction.