Differential Diagnosis for Severe Chest Pain
- Single most likely diagnosis
- Myocardial Infarction (MI): This is often the first consideration for severe chest pain due to its high prevalence and potential for serious outcomes. The pain is typically described as a heavy or squeezing sensation in the chest, radiating to the arm, neck, or jaw.
- Other Likely diagnoses
- Pulmonary Embolism (PE): Sudden onset of chest pain, especially if accompanied by shortness of breath, could indicate a pulmonary embolism. The pain is often sharp and stabbing, worsening with deep breaths.
- Pneumonia or Pleuritis: Infections like pneumonia can cause severe chest pain, especially if the pleura is involved (pleuritic chest pain), which worsens with breathing or coughing.
- Gastroesophageal Reflux Disease (GERD) or Esophageal Spasm: While less immediately life-threatening, severe chest pain can be caused by GERD or esophageal spasms, often related to eating or lying down.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Aortic Dissection: A tear in the aorta's inner layer can cause severe, tearing chest pain that radiates to the back. It's less common but highly lethal if not promptly treated.
- Cardiac Tamponade: Fluid accumulation in the pericardial sac can compress the heart, leading to severe chest pain, shortness of breath, and potentially fatal outcomes if not quickly addressed.
- Pulmonary Hypertension Crisis: A sudden increase in pulmonary artery pressure can cause severe chest pain, among other symptoms, and requires immediate medical attention.
- Rare diagnoses
- Spontaneous Pneumothorax: Sudden onset of severe chest pain and shortness of breath could indicate a collapsed lung, 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 sharp chest pain, often mistaken for more serious conditions.
- Pericarditis: Inflammation of the pericardium, the sac surrounding the heart, can cause sharp chest pain that improves with sitting up and leaning forward.