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 significant pain. This type of pain often worsens with movement or deep breathing.
- Asthma or Chronic Obstructive Pulmonary Disease (COPD): Respiratory conditions can cause chest tightness or pain, especially during exacerbations.
- Pneumonia or Pulmonary Embolism: Although less common, these conditions should be considered, especially if there are associated symptoms like fever, cough, or shortness of breath.
- Pericarditis: Inflammation of the pericardium, the sac surrounding the heart, can cause sharp chest pain that may improve with sitting up and leaning forward.
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 that radiates to the back. This is a life-threatening condition that needs prompt diagnosis and treatment.
- Pulmonary Embolism: A blood clot in the lungs can cause sudden onset of chest pain and shortness of breath, and it's crucial not to miss this diagnosis due to its high mortality rate.
Rare Diagnoses
- Esophageal Spasm or Rupture: Although uncommon, these conditions can cause severe chest pain and should be considered if other diagnoses are ruled out.
- Pneumothorax: A collapsed lung can cause sudden chest pain and shortness of breath, especially if it's a spontaneous pneumothorax in a young, healthy individual.
- Costochondritis (Tietze's Syndrome): Inflammation of the cartilage that connects the ribs to the breastbone can cause chest pain, but it's relatively rare and often diagnosed after excluding other conditions.