Acute Coronary Syndrome (ACS): This is often the first consideration in patients presenting with chest pain, especially if the pain is described as squeezing, pressure, or heaviness, and is associated with exertion or stress. The high prevalence of coronary artery disease in the general population and the potential for serious outcomes if not promptly treated make ACS a leading diagnosis.

Gastroesophageal Reflux Disease (GERD): Chest pain can be a symptom of GERD, especially if it is accompanied by regurgitation, dysphagia, or relieved by antacids. The pain is often described as burning and can mimic cardiac pain.
Musculoskeletal Pain: Strains or inflammation of the muscles or joints in the chest wall can cause pain that may be confused with more serious conditions. This diagnosis is more likely in patients with a history of trauma, overuse, or certain inflammatory conditions.
Pulmonary Embolism (PE): While not as common as ACS, PE is a significant cause of chest pain, especially in patients with risk factors such as recent surgery, immobilization, cancer, or a history of deep vein thrombosis. The pain is often sharp and worsens with deep breathing.

Aortic Dissection: A life-threatening condition where there is a tear in the aorta's inner layer. The pain is often severe, tearing, and radiates to the back. Missing this diagnosis can be fatal, so it must be considered in patients with high-risk features such as hypertension, aortic aneurysm, or certain genetic conditions.
Pneumothorax: Air in the pleural space can cause chest pain that is sharp and worsens with breathing. It is more likely in patients with lung disease, recent trauma, or those who are mechanically ventilated.
Pericarditis: Inflammation of the pericardium can cause chest pain that is sharp, improves with sitting up and leaning forward, and can be accompanied by a pericardial friction rub. It is a diagnosis that should not be missed due to its potential to lead to cardiac tamponade.

Esophageal Rupture: A severe condition where there is a tear in the esophagus, often due to forceful vomiting or iatrogenic causes. The pain is severe and constant, and the condition requires immediate surgical intervention.
Pneumomediastinum: Air in the mediastinum can cause chest pain and is often associated with conditions like asthma, or following certain medical procedures.
Spontaneous Coronary Artery Dissection (SCAD): A rare cause of ACS, more common in young women without traditional cardiovascular risk factors. It involves a tear in the coronary artery wall and can lead to myocardial infarction.