Differential Diagnosis for Chest Pain

The development of chest pain can be caused by a variety of conditions, ranging from benign to life-threatening. Here's a categorized differential diagnosis:

• Single Most Likely Diagnosis

  • Acute Coronary Syndrome (ACS): This includes conditions such as myocardial infarction (heart attack) and unstable angina. It's the most likely diagnosis due to the high prevalence of cardiovascular diseases and the typical presentation of chest pain.

• Other Likely Diagnoses

  • Pulmonary Embolism (PE): A blood clot in the lungs can cause sudden onset of chest pain, especially if it's associated with shortness of breath or coughing.
  • Pneumonia: Infection of the lung can cause chest pain, especially if it involves the pleura (pleuritic chest pain).
  • Gastroesophageal Reflux Disease (GERD): Stomach acid flowing back into the esophagus can cause chest pain that may mimic cardiac conditions.
  • Musculoskeletal Pain: Strain or inflammation of the muscles or bones in the chest wall can cause pain.

• Do Not Miss Diagnoses

  • Aortic Dissection: A tear in the aorta's inner layer can cause severe, tearing chest pain and is immediately life-threatening.
  • Pulmonary Hypertension: High blood pressure in the arteries of the lungs can lead to right heart failure and cause chest pain.
  • Cardiac Tamponade: Fluid accumulation in the sac around the heart can compress the heart and impede its function, leading to chest pain and potentially fatal outcomes if not promptly treated.

• Rare Diagnoses

  • Spontaneous Pneumothorax: Air in the space between the lungs and chest wall can cause sudden chest pain and shortness of breath, more common in tall, thin males or those with lung disease.
  • Esophageal Rupture: A tear in the esophagus can cause severe chest pain and is a medical emergency.
  • Pericarditis: Inflammation of the pericardium, the sac surrounding the heart, can cause sharp chest pain that may improve with leaning forward.

Each of these diagnoses has distinct characteristics and risk factors, and a thorough medical history, physical examination, and diagnostic tests are crucial for an accurate diagnosis.