Differential Diagnosis for Chest Pain
The differential diagnosis for chest pain is broad and can be categorized into several groups. Here's a breakdown of the potential causes:
- Single Most Likely Diagnosis
- Gastroesophageal Reflux Disease (GERD): This is often the most common cause of chest pain, especially if the pain is related to eating or lying down. GERD can cause a burning sensation in the chest that may be mistaken for cardiac pain.
- Other Likely Diagnoses
- Musculoskeletal Pain: Strained muscles or costochondritis (inflammation of the cartilage that connects the ribs to the breastbone) can cause chest pain, especially if the pain is sharp and worsens with movement.
- Asthma or Chronic Obstructive Pulmonary Disease (COPD): Respiratory conditions can cause chest tightness or pain, especially during exacerbations.
- Pulmonary Embolism: While less common, pulmonary embolism should be considered, especially in patients with risk factors such as recent surgery, immobilization, or cancer.
- Do Not Miss Diagnoses
- Myocardial Infarction (MI): Although not the most common cause, MI is a critical diagnosis that must be ruled out due to its high mortality rate if untreated. Risk factors include hypertension, diabetes, high cholesterol, and family history of heart disease.
- Aortic Dissection: A tear in the aorta's inner layer can cause severe, tearing chest pain that radiates to the back. This condition is life-threatening and requires immediate intervention.
- Pneumothorax: A collapsed lung can cause sudden, severe chest pain and shortness of breath, requiring urgent medical attention.
- Rare Diagnoses
- Pericarditis: Inflammation of the sac surrounding the heart can cause sharp chest pain that improves with sitting up and leaning forward.
- Esophageal Spasm or Rupture: These conditions are less common but can cause severe chest pain, often accompanied by difficulty swallowing.
- Pulmonary Artery Hypertension: Elevated blood pressure in the pulmonary arteries can lead to chest pain, especially during exertion, in addition to shortness of breath and fatigue.
Each of these diagnoses has distinct characteristics and risk factors that can help guide the diagnostic process. A thorough history, physical examination, and appropriate diagnostic tests are crucial for determining the underlying cause of chest pain.