Differential Diagnosis for Chest Pain, Nausea, and Vomiting
Single Most Likely Diagnosis
- Gastroesophageal Reflux Disease (GERD): This condition is common and can cause chest pain, nausea, and vomiting, especially after eating or at night. The symptoms can be exacerbated by lying down or consuming trigger foods.
Other Likely Diagnoses
- Acute Coronary Syndrome (ACS): Although more commonly associated with chest pain, ACS can also present with nausea and vomiting, particularly in women or diabetic patients. The pain is often described as squeezing or pressure.
- Pulmonary Embolism (PE): While PE typically presents with sudden onset dyspnea, it can also cause chest pain and nausea, especially if the embolism is large. Vomiting may occur due to the acute stress response.
- Pneumonia: Severe pneumonia can cause chest pain (pleuritic chest pain), nausea, and vomiting, especially if there is significant inflammation or if the patient is elderly or immunocompromised.
Do Not Miss Diagnoses
- Myocardial Infarction (MI): A life-threatening condition that requires immediate intervention. Even if the presentation is atypical (with nausea and vomiting), MI must be considered, especially in patients with risk factors.
- Aortic Dissection: A catastrophic condition that can present with sudden, severe chest pain and may be accompanied by nausea and vomiting. It is crucial to consider this diagnosis, especially in patients with hypertension or aortic disease.
- Esophageal Rupture: A rare but life-threatening condition that can cause severe chest pain, nausea, and vomiting. It often occurs after forceful vomiting or retching.
Rare Diagnoses
- Pericarditis: Inflammation of the pericardium can cause chest pain that may be accompanied by nausea and vomiting. The pain is often sharp and improves with sitting up and leaning forward.
- Boerhaave's Syndrome: A rare condition characterized by a spontaneous rupture of the esophagus, which can cause severe chest pain, nausea, and vomiting, often after intense or forceful vomiting.
- Pancreatitis: While abdominal pain is more common, pancreatitis can cause referred pain to the chest and may be accompanied by nausea and vomiting, especially if the pancreatic inflammation is severe.