Differential Diagnosis for a 22-year-old with Chest Pain

Single most likely diagnosis

• Musculoskeletal chest pain: This is often the most common cause of chest pain in young adults, resulting from strained muscles or inflammation in the chest wall. The age and lack of other specified risk factors make this a plausible first consideration.

Other Likely diagnoses

• Gastroesophageal reflux disease (GERD): GERD can cause chest pain that may be mistaken for cardiac issues. Young adults, especially those with dietary habits that include frequent consumption of acidic or spicy foods, are at risk.
• Anxiety or panic attack: Chest pain can be a symptom of anxiety or panic attacks, which are relatively common in young adults. The psychological stress and the physical symptoms of anxiety can mimic other serious conditions.
• Pneumonia or other respiratory infections: Although less common in young, otherwise healthy adults, respiratory infections can cause chest pain, especially if they involve the pleura.

Do Not Miss (ddxs that may not be likely, but would be deadly if missed)

• Myocardial infarction (MI): Although rare in young adults without risk factors, MI can occur and is a medical emergency. Early diagnosis and treatment are crucial for survival and minimizing heart damage.
• Pulmonary embolism (PE): This is a life-threatening condition that requires immediate medical attention. Risk factors such as recent travel, immobilization, or family history of clotting disorders increase the likelihood.
• Aortic dissection: A tear in the aorta's inner layer can cause severe, tearing chest pain. This condition is rare but life-threatening and requires immediate intervention.

Rare diagnoses

• Pericarditis: Inflammation of the pericardium, the sac surrounding the heart, can cause chest pain. It is less common and might be associated with recent viral infections or autoimmune conditions.
• Pneumothorax: Air in the pleural space can cause the lung to collapse partially or completely, leading to chest pain and shortness of breath. This condition is more common in tall, thin males or those with lung disease.
• Costochondritis (Tietze's syndrome): This condition involves inflammation of the cartilage that connects the ribs to the breastbone, causing chest pain. It is relatively rare and can be confused with more serious conditions.