Differential Diagnosis for Midsternal Chest Pain
Single Most Likely Diagnosis
- Gastroesophageal Reflux Disease (GERD): This condition is often associated with midsternal chest pain, especially after eating or at night, due to the reflux of stomach acid into the esophagus.
Other Likely Diagnoses
- Costochondritis: Inflammation of the cartilage that connects the ribs to the sternum can cause sharp, stabbing pain in the midsternal area.
- Musculoskeletal Strain: Strain or injury to the muscles or ligaments in the chest wall can lead to midsternal pain.
- Pericarditis: Inflammation of the pericardium, the sac surrounding the heart, can cause sharp, stabbing chest pain that may be midsternal in location.
- Esophageal Spasm: Abnormal contractions of the esophagus can cause chest pain that may be difficult to distinguish from cardiac pain.
Do Not Miss Diagnoses
- Acute Coronary Syndrome (ACS): Although less likely than GERD, ACS (including myocardial infarction) is a critical diagnosis that must be considered, especially in patients with risk factors such as hypertension, diabetes, or a family history of heart disease.
- Pulmonary Embolism: A blood clot in the lungs can cause sudden, severe chest pain that may be midsternal, along with shortness of breath and other symptoms.
- Aortic Dissection: A tear in the aorta can cause severe, tearing chest pain that may be midsternal, and is a medical emergency.
Rare Diagnoses
- Esophageal Rupture: A rare but serious condition where the esophagus tears, which can cause severe chest pain.
- Mediastinitis: Inflammation of the tissues in the mediastinum, which can cause chest pain, fever, and other symptoms.
- Tietze's Syndrome: A rare condition characterized by inflammation of the cartilage and surrounding tissues in the chest wall, which can cause chest pain and swelling.