Differential Diagnosis for Chest Pain in a 50-year-old Man
Single Most Likely Diagnosis
- Gastroesophageal Reflux Disease (GERD): This is a common cause of chest pain, especially in the absence of ECG and troponin abnormalities. The patient's age and lack of specific cardiac risk factors also point towards a non-cardiac etiology.
Other Likely Diagnoses
- Musculoskeletal Chest Pain: This is another common cause of chest pain, often related to strain or injury of the chest wall muscles or ribs.
- Anxiety or Panic Disorder: These conditions can manifest with chest pain, especially in the absence of other findings.
- Costochondritis: Inflammation of the cartilage that connects the ribs to the breastbone can cause sharp chest pain.
Do Not Miss Diagnoses
- Pulmonary Embolism (PE): Although the Wells score is low and the CXR is negative, PE is a potentially life-threatening condition that must be considered, especially if there are other risk factors present.
- Aortic Dissection: This is a rare but deadly condition that can cause chest pain, often described as tearing or ripping. A high index of suspicion is required, especially in patients with hypertension or other risk factors.
- Myocardial Infarction (MI) with Normal ECG: Although the ECG and troponin are normal, it is possible for an MI to occur without these typical findings, especially in patients with diabetes or women.
Rare Diagnoses
- Pneumothorax: A collapsed lung can cause chest pain, although this would typically be associated with other symptoms such as shortness of breath.
- Esophageal Spasm or Rupture: These conditions can cause severe chest pain, often accompanied by difficulty swallowing or other esophageal symptoms.
- Pericarditis: Inflammation of the sac surrounding the heart can cause chest pain, often accompanied by a pericardial friction rub on physical examination.