Differential Diagnosis of Chest Pain
The differential diagnosis of chest pain is broad 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: Strained muscles or costochondritis (inflammation of the cartilage that connects the ribs to the breastbone) can cause chest pain, especially if the pain is sharp and worsens with movement.
- Asthma or Chronic Obstructive Pulmonary Disease (COPD): Respiratory conditions can cause chest pain or tightness, especially if the patient is experiencing an exacerbation.
- Pneumonia or Pulmonary Embolism: Although less common, these conditions can cause chest pain, especially if the patient has a history of respiratory issues or recent travel.
- Do Not Miss Diagnoses
- Myocardial Infarction (MI): Although not the most common cause of chest pain, MI is a life-threatening condition that requires immediate attention. The classic presentation is a squeezing or pressure-like pain in the center of the chest that radiates to the arm, neck, or jaw.
- Aortic Dissection: A tear in the aorta can cause severe, tearing chest pain that radiates to the back. This condition is rare but deadly if missed.
- Pulmonary Embolism: A blood clot in the lungs can cause sudden, severe chest pain and shortness of breath. This condition requires immediate attention.
- Rare Diagnoses
- Pericarditis: Inflammation of the sac surrounding the heart can cause sharp, stabbing chest pain that worsens with movement.
- Esophageal Spasm: Abnormal muscle contractions in the esophagus can cause chest pain that mimics cardiac pain.
- Pneumothorax: A collapsed lung can cause sudden, severe chest pain and shortness of breath, especially if the patient has a history of lung disease.
It's essential to note that the diagnosis of chest pain requires a thorough medical history, physical examination, and diagnostic tests to determine the underlying cause.