Differential Diagnosis for Chest Pain
Single Most Likely Diagnosis
- Acute Coronary Syndrome (ACS): This is often the first consideration for chest pain, especially in patients with risk factors such as hypertension, diabetes, high cholesterol, or a family history of heart disease. The pain is typically described as a pressure or heaviness in the chest that may radiate to the arm, neck, or jaw.
Other Likely Diagnoses
- Gastroesophageal Reflux Disease (GERD): Chest pain can be a symptom of GERD, especially if it worsens with eating or lying down. The pain is often burning in nature and can be accompanied by regurgitation or dysphagia.
- Musculoskeletal Pain: Strains or inflammation of the muscles or joints in the chest wall can cause pain that may mimic cardiac or pulmonary issues. This type of pain often improves with movement or position change.
- 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. The pain is typically sharp and worsens with deep breathing.
- Pneumonia or Pleuritis: Infections or inflammation of the lung tissue or pleura can cause chest pain that is often sharp and worsens with deep breathing or coughing.
Do Not Miss Diagnoses
- Aortic Dissection: A life-threatening condition where the inner layer of the aorta tears, causing severe, tearing chest pain that radiates to the back. It is crucial to consider this diagnosis, especially in patients with hypertension or aortic aneurysm.
- Pulmonary Embolism (also listed under other likely diagnoses due to its relatively higher likelihood but included here for emphasis): The risk of missing PE is significant due to its variable presentation, 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, shortness of breath, and potentially fatal outcomes if not recognized and treated.
Rare Diagnoses
- Esophageal Rupture: A severe condition where the esophagus tears, often due to forceful vomiting or an instrument during medical procedures. It presents with severe chest pain and requires immediate surgical intervention.
- Spontaneous Pneumothorax: Air entering the space between the lung and chest wall can cause sudden, sharp chest pain and shortness of breath, especially in tall, thin males or those with lung disease.
- Pericarditis: Inflammation of the pericardium, the sac surrounding the heart, can cause sharp chest pain that improves with sitting up and leaning forward. It can be idiopathic or associated with various conditions, including viral infections or autoimmune diseases.