What is the initial diagnosis for a patient presenting with chest pain at rest, sob, and a negative troponin test?

When evaluating a patient who presents with chest pain at rest and shortness of breath (SOB) alongside a negative troponin test, the primary consideration in diagnosis is the nature of the symptoms and the troponin results. In this situation, the symptoms of chest pain at rest along with shortness of breath raise a concern for acute coronary syndrome (ACS). However, the negative troponin test indicates that there is no detectable myocardial injury at the time of assessment.

Unstable angina is characterized by new or worsening chest pain at rest without elevation of troponin levels, indicating that while the heart may be under significant strain or ischemic, it has not suffered irreparable damage. The absence of troponin elevation contrasts with conditions like NSTEMI (non-ST elevation myocardial infarction) and inferior MI, which typically present with troponin elevation, signifying myocardial tissue damage.

Pericarditis, while it can cause chest pain, usually presents differently in terms of timing and may not be steady or occur specifically at rest like unstable angina does. Additionally, it often involves a distinct pleuritic pain that may improve when leaning forward.

Thus, given the patient's current presentation—chest pain at rest, sob, and