Differential Diagnosis for Non-Cardiac Chest Pain
Single Most Likely Diagnosis
- Gastroesophageal Reflux Disease (GERD): This is often the most common cause of non-cardiac chest pain. The symptoms can mimic cardiac issues, such as chest tightness or burning, and are usually related to eating or lying down.
Other Likely Diagnoses
- Musculoskeletal Pain: Strains or inflammation in the muscles or joints of the chest wall can cause pain that feels like it's coming from the chest. This type of pain often worsens with movement or pressure on the affected area.
- Esophageal Spasm: Spasms of the esophagus can cause severe chest pain that may be mistaken for a heart attack. These spasms can be triggered by certain foods, stress, or other factors.
- Pulmonary Causes: Conditions like pneumonia, pleuritis, or pulmonary embolism can cause chest pain, though these would typically be accompanied by other symptoms such as cough, fever, or shortness of breath.
Do Not Miss Diagnoses
- Pulmonary Embolism: Although less common, pulmonary embolism is a life-threatening condition that requires immediate medical attention. Chest pain associated with shortness of breath, tachypnea, or syncope should raise suspicion for this diagnosis.
- Aortic Dissection: A tear in the aorta can cause severe, tearing chest pain that radiates to the back. This is a medical emergency that requires prompt diagnosis and treatment.
- Esophageal Rupture: A rupture of the esophagus can cause severe chest pain and is a life-threatening condition. It might be associated with difficulty swallowing, vomiting, or severe pain after eating.
Rare Diagnoses
- Pneumothorax: Air in the pleural space can cause chest pain and shortness of breath. While not extremely rare, it's less common than other causes of non-cardiac chest pain and often occurs in specific contexts (e.g., trauma, lung disease).
- Costochondritis (Tietze's Syndrome): Inflammation of the cartilage that connects the ribs to the breastbone can cause chest pain. It's more common in younger individuals and can be confused with cardiac issues.
- Herpes Zoster (Shingles): Before the rash appears, shingles can cause pain in a dermatomal distribution, which might be mistaken for non-cardiac chest pain if it affects the chest area.