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 possible 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 relieved by antacids. 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 coughing or shortness of breath.
  • Pneumonia: Infection of the lung can cause chest pain that worsens with deep breathing or coughing.
  • Pulmonary Embolism: While less common, a blood clot in the lungs can cause sudden onset of chest pain and shortness of breath.

• Do Not Miss Diagnoses

  • Myocardial Infarction (Heart Attack): Although not the most common cause, missing a heart attack can be fatal. The pain is typically described as a heavy or squeezing sensation in the center of the chest.
  • Aortic Dissection: A tear in the aorta can cause severe, tearing chest pain that radiates to the back. This condition is life-threatening and requires immediate intervention.
  • Pulmonary Embolism: As mentioned earlier, but included here due to its potential severity and the importance of not missing this diagnosis.

• Rare Diagnoses

  • Pericarditis: Inflammation of the sac surrounding the heart can cause sharp chest pain that improves with leaning forward.
  • Esophageal Spasm or Rupture: Spasms can cause severe chest pain, while a rupture is a medical emergency with severe, constant pain.
  • Pneumothorax: Air in the space between the lung and chest wall can cause sudden chest pain and shortness of breath, more common in tall, thin males or those with lung disease.
  • Costochondritis (Tietze's Syndrome): Inflammation of the cartilage that connects the ribs to the breastbone can cause chest pain, often tender to the touch.