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 potential 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. The pain can mimic cardiac ischemia but is usually accompanied by other symptoms like heartburn and regurgitation.

• Other Likely Diagnoses

  • Musculoskeletal Pain: Chest wall pain from strained muscles or costochondritis is common and can be diagnosed based on tenderness to palpation and movement.
  • Asthma or Chronic Obstructive Pulmonary Disease (COPD) Exacerbation: These conditions can cause chest tightness or pain, especially if associated with wheezing, cough, or shortness of breath.
  • Pulmonary Embolism: While less common than other causes, pulmonary embolism should be considered, especially in patients with risk factors like recent travel, surgery, or family history of clotting disorders.
  • Pneumonia: Infection of the lung can cause pleuritic chest pain, which worsens with deep breathing or coughing.

• Do Not Miss Diagnoses

  • Myocardial Infarction (MI): Although not the most common cause, MI is potentially life-threatening and requires immediate intervention. Risk factors include a history of coronary artery disease, hypertension, diabetes, high cholesterol, and smoking.
  • Aortic Dissection: A tear in the aorta's inner layer can cause severe, tearing chest pain that radiates to the back. It's more common in patients with hypertension or aortic aneurysm.
  • Pulmonary Embolism (mentioned earlier but also belongs here): Due to its potential severity and the fact that it can present subtly, it's crucial not to miss this diagnosis.
  • Esophageal Rupture: A severe condition that can mimic myocardial infarction but is associated with severe chest pain after vomiting or eating.

• Rare Diagnoses

  • Pericarditis: Inflammation of the pericardium, the sac surrounding the heart, can cause sharp chest pain that improves with leaning forward.
  • Pneumothorax: Air in the pleural space can cause sudden, sharp chest pain and shortness of breath, more common in tall, thin males or those with lung disease.
  • Mediastinitis: Inflammation of the tissues in the mediastinum can cause severe chest pain, often associated with infection or recent surgery.

Each of these diagnoses has distinct characteristics and risk factors that can guide the clinician towards the correct diagnosis. A thorough history, physical examination, and appropriate diagnostic tests are essential for accurately diagnosing the cause of chest pain.