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 positional. GERD can cause a burning sensation in the chest that may be mistaken for cardiac pain.
• Other Likely Diagnoses
  • Musculoskeletal Pain: Strains or inflammation of the muscles and joints in the chest wall can cause significant pain. This type of pain often worsens with movement or deep breathing.
  • Asthma or Chronic Obstructive Pulmonary Disease (COPD) Exacerbation: Respiratory conditions can lead to chest pain, especially if there's associated wheezing, coughing, or shortness of breath.
  • Pulmonary Embolism: While less common than other causes, pulmonary embolism should be considered, especially in patients with risk factors such as recent travel, surgery, or family history of clotting disorders.
• Do Not Miss Diagnoses
  • Myocardial Infarction (MI): Although not the most common cause of chest pain, MI is potentially life-threatening and requires immediate attention. The classic presentation includes chest pain radiating to the arm, jaw, or neck, accompanied by shortness of breath, nausea, or diaphoresis.
  • Aortic Dissection: This is a medical emergency where the inner layer of the aorta tears. It presents with severe, tearing chest pain that radiates to the back.
  • Pneumothorax: Air in the pleural space can cause the lung to collapse, leading to sudden, severe chest pain and shortness of breath.
• Rare Diagnoses
  • Pericarditis: Inflammation of the pericardium, 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. Esophageal rupture is a medical emergency.
  • Pulmonary Artery Hypertension: This condition can lead to chest pain due to right ventricular strain, but it's relatively rare and usually associated with other symptoms like syncope or edema.

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 cause of chest pain.