Differential Diagnosis for Chest Heaviness

• Single most likely diagnosis
  • Acute Coronary Syndrome (ACS): This is the most likely diagnosis due to the presentation of chest heaviness, which is a common symptom of myocardial infarction (heart attack) or unstable angina. The symptomatology aligns closely with cardiac issues, making ACS a prime consideration.
• Other Likely diagnoses
  • Pulmonary Embolism (PE): Although less common than ACS, PE can present with sudden onset of chest heaviness or discomfort, especially if it is large or involves multiple segments of the lung. Other symptoms might include shortness of breath and tachycardia.
  • Pneumonia: Inflammation of the lung tissue can cause chest heaviness, especially if the pneumonia is severe or involves a large area of the lung. Symptoms might also include fever, cough, and difficulty breathing.
  • Gastroesophageal Reflux Disease (GERD): GERD can cause chest discomfort or heaviness, often described as burning, which might be mistaken for cardiac issues. The discomfort is usually related to eating or lying down.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
  • Aortic Dissection: A life-threatening condition where the inner layer of the aorta tears, causing severe, sudden chest pain that can be described as heaviness. It is less common but critical to diagnose promptly.
  • Cardiac Tamponade: Fluid accumulation in the sac around the heart can compress the heart, leading to reduced cardiac output and potentially fatal outcomes if not recognized and treated immediately. Symptoms can include chest heaviness, shortness of breath, and hypotension.
  • Pulmonary Hypertension Crisis: A sudden increase in pulmonary artery pressure can lead to right heart failure, presenting with symptoms such as chest heaviness, syncope, and severe shortness of breath.
• Rare diagnoses
  • Pericarditis: Inflammation of the pericardium, the sac surrounding the heart, can cause chest pain or heaviness, typically sharp and improving with sitting up and leaning forward. It is less common than other cardiac conditions but should be considered, especially with specific electrocardiogram (ECG) changes.
  • Esophageal Spasm: Abnormal contractions of the esophagus can cause chest heaviness or pain, often related to swallowing or eating. It is a rare cause of chest symptoms but can be considered if other diagnoses are ruled out.