Differential Diagnosis for Chest Pain in a Hypertensive Patient

Single Most Likely Diagnosis

• Gastroesophageal Reflux Disease (GERD): This is a common condition that can cause chest pain, especially in hypertensive patients who may be taking medications that can exacerbate reflux. The pain is often described as a burning sensation and can be related to eating or lying down.

Other Likely Diagnoses

• Hypertensive Heart Disease: Hypertension can lead to heart failure, coronary artery disease, or cardiac arrhythmias, all of which can cause chest pain. The mechanism involves increased workload on the heart, leading to ischemia or dysfunction.
• Anxiety or Panic Disorder: Hypertensive patients may experience anxiety, which can manifest as chest pain. The pain is often sharp and accompanied by other symptoms like palpitations, shortness of breath, and fear of dying.
• Musculoskeletal Pain: Strain or inflammation of the muscles or joints in the chest wall can cause pain that may be mistaken for cardiac pain. This is common in individuals who engage in physical activity or have poor posture.

Do Not Miss Diagnoses

• Myocardial Infarction (MI): Although not the most common cause, MI is a critical diagnosis to consider in any patient with chest pain, especially those with hypertension. The pain is typically described as a heavy or squeezing sensation and may radiate to the arm, neck, or jaw.
• Aortic Dissection: This is a life-threatening condition where there is a tear in the aorta's inner layer. Hypertension is a significant risk factor. The pain is often severe, tearing, and radiates to the back.
• Pulmonary Embolism (PE): While less common, PE can cause chest pain, especially in patients with risk factors like hypertension. The pain is typically sharp and worsens with deep breathing or coughing.

Rare Diagnoses

• Pericarditis: Inflammation of the pericardium, the sac surrounding the heart, can cause chest pain. The pain is often sharp and improves with sitting up and leaning forward.
• Pneumothorax: Air in the pleural space can cause chest pain and is more common in tall, thin males or those with lung disease. The pain is typically sharp and worsens with deep breathing.
• Esophageal Spasm or Rupture: These conditions can cause severe chest pain and are more common in patients with a history of esophageal disease. The pain can mimic cardiac pain and is often accompanied by difficulty swallowing.