Differential Diagnosis for Chest Pain
- Single Most Likely Diagnosis
- Acute Coronary Syndrome (ACS): This is the most likely diagnosis due to the high prevalence of coronary artery disease and the potential for life-threatening complications if not promptly treated. ACS includes conditions such as myocardial infarction (MI) and unstable angina.
- Other Likely Diagnoses
- Gastroesophageal Reflux Disease (GERD): Chest pain can be a symptom of GERD, especially if it is accompanied by regurgitation, dysphagia, or relieved by antacids.
- Musculoskeletal Pain: Costochondritis, muscle strain, or rib fractures can cause chest pain, often reproducible by palpation or movement.
- Pulmonary Embolism (PE): While less common than ACS, PE is a significant cause of chest pain, especially in patients with risk factors such as recent surgery, immobilization, or cancer.
- Pneumonia or Pleuritis: Infections or inflammation of the lung or pleura can cause chest pain, often accompanied by fever, cough, or shortness of breath.
- Do Not Miss Diagnoses
- Aortic Dissection: A life-threatening condition where the aorta tears, causing severe, tearing chest pain that radiates to the back. It requires immediate surgical intervention.
- Pulmonary Embolism (also listed under other likely diagnoses, but included here due to its potential severity): The risk of missing PE is high, and it can be fatal if not treated promptly.
- Cardiac Tamponade: Fluid accumulation in the pericardial sac can compress the heart, leading to chest pain, hypotension, and potentially fatal outcomes if not drained.
- Rare Diagnoses
- Esophageal Rupture or Perforation: A rare but serious condition that can cause severe chest pain, often accompanied by vomiting, fever, or difficulty swallowing.
- Spontaneous Pneumothorax: Air in the pleural space can cause sudden, severe chest pain and shortness of breath, more common in tall, thin males or those with lung disease.
- Mitral Valve Prolapse: A condition where the mitral valve does not close properly, potentially causing chest pain, palpitations, or shortness of breath, though often asymptomatic.