What is the differential diagnosis (DDX) of chest pain?

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Last updated: May 23, 2025 • View editorial policy

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.

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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.