What is the differential diagnosis of chest pain?

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Last updated: May 14, 2025View editorial policy

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Differential Diagnosis for Chest Pain

The following is a list of potential causes for chest pain, categorized by likelihood and potential impact.

  • Single most likely diagnosis

    • Gastroesophageal reflux disease (GERD): This is a common condition that can cause chest pain, especially after eating or at night. The pain is often described as a burning sensation and can be accompanied by regurgitation of food.
  • Other Likely diagnoses

    • Musculoskeletal pain: Strained muscles or inflammation in the chest wall can cause pain, especially with movement or deep breathing.
    • Asthma or chronic obstructive pulmonary disease (COPD): Respiratory conditions can cause chest pain, especially if associated with wheezing, coughing, or shortness of breath.
    • Pneumonia: Infection in the lungs can cause chest pain, fever, and cough.
    • Pulmonary embolism: A blood clot in the lungs can cause sudden, severe chest pain, especially with deep breathing or coughing.
  • Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)

    • Myocardial infarction (heart attack): A blockage in the coronary arteries can cause severe, crushing chest pain, especially with exertion or stress.
    • Aortic dissection: A tear in the aorta can cause severe, tearing chest pain, especially with radiation to the back.
    • Pulmonary embolism: As mentioned earlier, a blood clot in the lungs can be life-threatening if not treated promptly.
    • Esophageal rupture: A tear in the esophagus can cause severe chest pain, especially with swallowing or vomiting.
  • Rare diagnoses

    • Pericarditis: Inflammation of the sac surrounding the heart can cause chest pain, especially with deep breathing or movement.
    • Pneumothorax: A collapsed lung can cause sudden, severe chest pain, especially with deep breathing or coughing.
    • Costochondritis: Inflammation of the cartilage connecting the ribs to the breastbone can cause chest pain, especially with movement or deep breathing.
    • Thoracic outlet syndrome: Compression of the nerves or blood vessels in the thoracic outlet can cause chest pain, especially with movement or exertion.

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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