Differential Diagnosis for GERD vs ACS

When attempting to distinguish Gastroesophageal Reflux Disease (GERD) from Acute Coronary Syndrome (ACS), it's crucial to consider a broad range of potential diagnoses due to the overlap in symptoms and the critical nature of ACS. Here's a structured approach to the differential diagnosis:

• Single Most Likely Diagnosis:

  • GERD: This is often the most likely diagnosis in patients presenting with chest pain or discomfort that is related to eating, lying down, or is relieved by antacids. The symptoms of GERD can mimic those of ACS, but the presence of typical reflux symptoms such as heartburn and regurgitation points towards GERD.

• Other Likely Diagnoses:

  • ACS: Although the focus is on distinguishing it from GERD, ACS is a critical diagnosis to consider, especially in patients with risk factors for coronary artery disease. The presentation can vary from typical chest pain to more atypical symptoms.
  • Esophageal spasm: This condition can cause chest pain that may be difficult to distinguish from GERD or ACS. The pain is often sharp and can be accompanied by dysphagia.
  • Peptic ulcer disease: Symptoms can sometimes overlap with GERD, especially if the ulcer is located in the duodenum or stomach and causes referred pain to the chest.

• Do Not Miss Diagnoses:

  • Pulmonary embolism: Although less common, pulmonary embolism can present with sudden onset chest pain and must be considered, especially in patients with risk factors such as recent surgery, immobilization, or known thrombophilic conditions.
  • Aortic dissection: This is a medical emergency that presents with severe, tearing chest pain. It's less common but critical not to miss due to its high mortality rate.
  • Pericarditis: Inflammation of the pericardium can cause chest pain that may be confused with ACS or GERD. The pain is often sharp and improves with leaning forward.

• Rare Diagnoses:

  • Esophageal rupture (Boerhaave's syndrome): A rare but serious condition that can present with severe chest pain after vomiting or other activities that increase esophageal pressure.
  • Pancreatitis: While more commonly presenting with abdominal pain, pancreatitis can cause referred pain to the chest, especially if the inflammation affects the tail of the pancreas near the diaphragm.
  • Costochondritis (Tietze's syndrome): Inflammation of the cartilages and bones of the chest wall can cause sharp pains that may be mistaken for cardiac or esophageal issues.

Each of these diagnoses requires careful consideration of the patient's history, physical examination, and diagnostic tests to accurately distinguish between GERD and ACS, as well as to identify other potential causes of chest pain.