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

  • Gastroesophageal Reflux Disease (GERD): This is often the most common cause of chest pain in the general population, especially in the absence of cardiac risk factors. The pain is typically described as a burning sensation that may radiate to the neck or arms and can be exacerbated by lying down or eating certain foods.

• Other Likely Diagnoses

  • Musculoskeletal Pain: This includes costochondritis (inflammation of the cartilage that connects the ribs to the sternum) and muscle strain. The pain is usually sharp, localized, and can be reproduced by pressing on the affected area.
  • Asthma or Chronic Obstructive Pulmonary Disease (COPD) Exacerbation: These conditions can cause chest tightness or pain, especially if associated with wheezing, cough, or shortness of breath.
  • Pulmonary Embolism: While not as common as other causes, it's a significant consideration, especially in patients with risk factors such as recent surgery, immobilization, cancer, or a history of deep vein thrombosis. The pain is often sudden, sharp, and worsens with deep breathing.

• Do Not Miss Diagnoses

  • Myocardial Infarction (MI): Although not the most common cause, MI is a critical diagnosis that must be considered, especially in patients with risk factors such as hypertension, diabetes, high cholesterol, smoking, or a family history of heart disease. The pain is typically described as a heavy, squeezing sensation that may radiate to the arm, neck, or jaw.
  • Aortic Dissection: This is a life-threatening condition where there is a tear in the aorta's inner layer. The pain is often severe, tearing, and radiates to the back. Risk factors include hypertension, aortic aneurysm, and certain genetic conditions like Marfan syndrome.
  • Pneumothorax: Air in the pleural space can cause sudden, sharp chest pain that worsens with breathing. It's more common in tall, thin males or those with lung disease.

• Rare Diagnoses

  • Pericarditis: Inflammation of the pericardium, the sac surrounding the heart, can cause sharp, stabbing chest pain that may improve with sitting up and leaning forward. It can be associated with fever, fatigue, and a pericardial friction rub on examination.
  • Esophageal Spasm or Rupture: These conditions can cause severe, sudden chest pain. Esophageal rupture is a medical emergency and may be associated with severe pain, vomiting, and signs of sepsis.
  • Pulmonary Artery Hypertension: This condition can cause chest pain due to right ventricular ischemia or infarction, especially during exertion. It's often associated with shortness of breath, fatigue, and signs of right heart failure.