Differential Diagnosis for Chest Pain

The following is a comprehensive differential diagnosis for chest pain, categorized for clarity and emphasis on critical conditions.

• Single Most Likely Diagnosis

  • Acute Coronary Syndrome (ACS): This includes conditions such as myocardial infarction (MI) and unstable angina. It is the most common cause of chest pain in adults, especially those with risk factors like hypertension, diabetes, smoking, and high cholesterol. The presentation typically involves chest pain described as pressure, tightness, or heaviness, often radiating to the arm, neck, or jaw, and may be accompanied by shortness of breath, nausea, or diaphoresis.

• Other Likely Diagnoses

  • Gastroesophageal Reflux Disease (GERD): GERD can cause chest pain that mimics cardiac conditions, often described as a burning sensation that may worsen with lying down or improve with antacids.
  • Musculoskeletal Pain: Strains or inflammation of the muscles and joints in the chest wall can cause sharp pains that are usually exacerbated by movement or deep breathing.
  • Pulmonary Embolism (PE): While not as common as ACS, PE is a significant cause of chest pain, especially in patients with risk factors like recent surgery, immobilization, or cancer. The pain is typically sharp and worsens with deep breathing.
  • Pneumonia or Pleuritis: Infections of the lung or inflammation of the pleura can cause chest pain, often accompanied by fever, cough, and shortness of breath.

• 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 requires immediate medical attention.
  • Pulmonary Embolism (PE): Already mentioned, but critical enough to be emphasized again due to its potential for being overlooked and its high mortality rate if untreated.
  • Esophageal Rupture: A rare but dangerous condition that can cause severe chest pain, often after forceful vomiting or swallowing a foreign object.

• Rare Diagnoses

  • Pericarditis: Inflammation of the pericardium, the sac surrounding the heart, can cause sharp chest pain that improves with sitting up and leaning forward.
  • Pneumothorax: Collapse of the lung can cause sudden, sharp chest pain and shortness of breath, often in tall, thin individuals or those with lung disease.
  • Costochondritis (Tietze's Syndrome): Inflammation of the cartilage that connects the ribs to the breastbone, causing sharp pains in the chest wall.

Each of these diagnoses has distinct characteristics and risk factors, and a thorough history, physical examination, and diagnostic tests are essential for accurate diagnosis and appropriate management.