Differential Diagnosis for Chest Pain

The following is a differential diagnosis for chest pain, categorized for clarity and emphasis on critical conditions.

• Single Most Likely Diagnosis

  • Gastroesophageal Reflux Disease (GERD): This is often the most common cause of chest pain in the general population, especially if the pain is related to eating or relieved by antacids. The pain can mimic cardiac conditions, making it a first consideration.

• Other Likely Diagnoses

  • Musculoskeletal Pain: Strains or inflammation of the muscles and joints in the chest wall can cause significant pain, often reproducible by movement or pressure.
  • Asthma or Chronic Obstructive Pulmonary Disease (COPD) Exacerbation: Respiratory conditions can cause chest pain, especially if there's associated coughing or shortness of breath.
  • Pulmonary Embolism: While less common, this condition is critical and should be considered, especially in patients with risk factors such as recent travel, surgery, or family history of clotting disorders.
  • Pneumonia: Infection of the lung can cause chest pain, typically accompanied by fever, cough, and shortness of breath.

• Do Not Miss Diagnoses

  • Myocardial Infarction (MI): Heart attack is a medical emergency that requires immediate attention. Even if it's not the most likely diagnosis based on initial presentation, it must be ruled out due to its high mortality rate if untreated.
  • Aortic Dissection: A tear in the aorta's inner layer can cause severe, tearing chest pain and is immediately life-threatening.
  • Pulmonary Embolism (mentioned earlier but also belongs here): Due to its potential for sudden death, it's crucial not to miss this diagnosis.
  • Esophageal Rupture: A severe condition that can mimic myocardial infarction or other causes of chest pain but requires immediate surgical intervention.

• Rare Diagnoses

  • Pericarditis: Inflammation of the sac surrounding the heart can cause sharp chest pain that improves with leaning forward.
  • Pneumothorax: Collapse of the lung 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 confused with cardiac issues.
  • Mitral Valve Prolapse: A condition where the two valve flaps of the mitral valve do not close smoothly but instead bulge (prolapse) upward into the left atrium when the heart contracts, can cause chest pain among other symptoms.