Differential Diagnosis for Chest Pain
Besides Acute Coronary Syndrome (ACS), there are several other medical conditions that can cause chest pain. The differential diagnosis can be categorized as follows:
- Single Most Likely Diagnosis
- Pulmonary Embolism (PE): This is a leading cause of chest pain that is not related to ACS. The symptoms can be similar, including sudden onset of chest pain and shortness of breath, making it a critical diagnosis to consider.
- Other Likely Diagnoses
- Gastroesophageal Reflux Disease (GERD): GERD can cause chest pain that mimics ACS, especially if the pain is related to eating or lying down.
- Pneumonia: Infections like pneumonia can cause chest pain, especially if the pain is accompanied by fever, cough, or difficulty breathing.
- Pleurisy: Inflammation of the pleura can cause sharp chest pain that worsens with breathing.
- Costochondritis: Inflammation of the cartilage that connects the ribs to the breastbone can cause chest pain.
- Do Not Miss Diagnoses
- Aortic Dissection: A tear in the aorta can cause severe, tearing chest pain and is a medical emergency.
- Pneumothorax: A collapsed lung can cause sudden chest pain and shortness of breath.
- Esophageal Rupture: A tear in the esophagus can cause severe chest pain and is a medical emergency.
- Pericarditis: Inflammation of the sac surrounding the heart can cause chest pain that improves with leaning forward.
- Rare Diagnoses
- Hypertrophic Cardiomyopathy: A condition where the heart muscle becomes thickened, which can cause chest pain and shortness of breath.
- Mitral Valve Prolapse: A condition where the mitral valve does not close properly, which can cause chest pain and palpitations.
- Sickle Cell Crisis: A condition where abnormal red blood cells cause episodes of pain, including chest pain.
Each of these diagnoses has distinct characteristics and risk factors, and a thorough medical history, physical examination, and diagnostic tests are necessary to determine the underlying cause of chest pain.