If a patient reports sudden, intense pain under the sternum, what condition should be suspected?

When a patient reports sudden, intense pain under the sternum, one of the primary conditions to suspect is a heart attack. This type of pain, often described as a pressure or squeezing sensation, may be accompanied by other symptoms such as shortness of breath, sweating, nausea, or radiating pain in the jaw, neck, or arms. This presentation aligns with the typical signs of a myocardial infarction, where the heart muscle is not getting enough blood due to a blockage in the coronary arteries.

In contrast, while heartburn can cause discomfort under the sternum, it is usually associated with a burning sensation related to acid reflux and does not typically present as sudden and intense pain. Gastritis, on the other hand, involves inflammation of the stomach lining and may cause pain, but it is generally less acute and often associated with meals. Pneumonia typically presents with respiratory symptoms, such as cough and difficulty breathing, rather than isolated intense pain under the sternum.

Thus, in the context of sudden, intense pain, a heart attack aligns most closely with the severity and nature of the symptoms described.