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:
- 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. GERD can cause a burning sensation in the chest that may be mistaken for cardiac pain.
- Other Likely Diagnoses + Musculoskeletal Pain: Strains or inflammation of the muscles and joints in the chest wall can cause pain that may be confused with more serious conditions. + Asthma or Chronic Obstructive Pulmonary Disease (COPD): Respiratory conditions can cause chest tightness or pain, especially during exacerbations. + Pneumonia or Bronchitis: Infections of the lungs can cause chest pain, usually accompanied by cough, fever, and other respiratory symptoms. + Pulmonary Embolism: While less common, pulmonary embolism should be considered, especially in patients with risk factors such as recent travel, surgery, or family history of clotting disorders.
- Do Not Miss Diagnoses + Myocardial Infarction (MI): Heart attack is a medical emergency that requires immediate attention. Even if it's not the most likely diagnosis, missing an MI can be fatal. + Aortic Dissection: A tear in the aorta's inner layer can cause severe, tearing chest pain and is life-threatening if not promptly treated. + Pneumothorax: A collapsed lung can cause sudden, severe chest pain and shortness of breath, requiring urgent medical intervention. + Esophageal Rupture: A tear in the esophagus can lead to severe chest pain and is a medical emergency.
- Rare Diagnoses + Pericarditis: Inflammation of the sac surrounding the heart can cause chest pain that improves with leaning forward. + Costochondritis (Tietze's Syndrome): Inflammation of the cartilage that connects the ribs to the breastbone can cause sharp chest pain. + Sickle Cell Crisis: In patients with sickle cell disease, a crisis can cause chest pain due to vaso-occlusion. + Pulmonary Artery Hypertension: Elevated blood pressure in the pulmonary arteries can cause chest pain, especially during exertion.
Each of these diagnoses has distinct characteristics and risk factors. A thorough medical history, physical examination, and diagnostic tests are essential for determining the underlying cause of chest pain.