Differential Diagnosis for Chest Pain
The differential diagnosis for chest pain is extensive and can be categorized into several groups. Here's a breakdown of the possible causes, organized by their likelihood and potential impact:
Single Most Likely Diagnosis
- Gastroesophageal Reflux Disease (GERD): This is often the most common cause of chest pain, especially if the pain is related to eating or worsens with lying down. Justification: GERD is prevalent, and its symptoms can mimic cardiac issues, making it a frequent initial consideration.
- Musculoskeletal Pain: Including costochondritis or muscle strain, which can cause sharp pains that are exacerbated by movement or deep breathing. Justification: Musculoskeletal issues are common and can cause chest pain that may be confused with more serious conditions.
Other Likely Diagnoses
- Acute Coronary Syndrome (ACS): Including myocardial infarction (MI) and unstable angina, characterized by chest pain that may radiate to the arm, neck, or jaw, and is often associated with exertion. Justification: While not the most common cause, ACS is a critical diagnosis that must be considered due to its high morbidity and mortality.
- Pulmonary Embolism (PE): Sudden onset of chest pain that worsens with deep breathing, often accompanied by shortness of breath. Justification: PE is a significant and potentially life-threatening condition that requires prompt diagnosis and treatment.
- Pneumonia: Can cause chest pain, especially if the infection involves the pleura. Justification: Pneumonia is a common condition that can present with chest pain, among other symptoms like cough and fever.
Do Not Miss Diagnoses
- Aortic Dissection: A life-threatening condition characterized by severe, tearing chest pain that radiates to the back. Justification: Although rare, aortic dissection has a high mortality rate if not promptly diagnosed and treated.
- Esophageal Rupture: Presents with severe chest pain after vomiting or other esophageal trauma. Justification: This condition is rare but has a high mortality rate if not recognized and treated immediately.
- Pulmonary Hypertension: Can cause chest pain due to right ventricular strain. Justification: While less common, pulmonary hypertension is a serious condition that can lead to significant morbidity and mortality if not addressed.
Rare Diagnoses
- Pericarditis: Inflammation of the pericardium, which can cause sharp chest pain that improves with sitting up and leaning forward. Justification: Pericarditis is less common but can be a cause of chest pain, especially in patients with certain risk factors like recent viral illness.
- Mitral Valve Prolapse: Can cause chest pain, although this is less common. Justification: While mitral valve prolapse is often asymptomatic, it can occasionally cause chest pain, usually due to mitral regurgitation or associated conditions.
- Tietze's Syndrome: A rare condition characterized by inflammation of the cartilages and surrounding tissues of the ribs, causing chest pain. Justification: Tietze's syndrome is rare and often confused with costochondritis but can cause significant discomfort.