Differential Diagnosis for Chest Discomfort
Single Most Likely Diagnosis
- Gastroesophageal Reflux Disease (GERD): This is often the most common cause of chest discomfort, especially if the discomfort is related to eating or lying down. The symptoms can mimic cardiac issues, making it a crucial initial consideration.
Other Likely Diagnoses
- Musculoskeletal Pain: Strains or inflammation in the muscles or joints of the chest wall can cause significant discomfort. This is often related to physical activity or trauma.
- Asthma or Chronic Obstructive Pulmonary Disease (COPD): Respiratory conditions can cause chest tightness or discomfort, especially during exacerbations or if not well-managed.
- Panic Attack or Anxiety: These can cause chest discomfort or pain, often accompanied by other symptoms like shortness of breath, palpitations, and fear of dying.
Do Not Miss Diagnoses
- Myocardial Infarction (Heart Attack): Although not the most common cause, missing a heart attack can be fatal. It typically presents with chest pain that may radiate to the arm, neck, or jaw, and is associated with shortness of breath, sweating, and nausea.
- Pulmonary Embolism: A blood clot in the lungs can cause sudden onset of chest pain and shortness of breath. It's critical to consider this diagnosis, especially in patients with risk factors like recent surgery, immobilization, or cancer.
- Aortic Dissection: A tear in the aorta can cause severe, tearing chest pain that radiates to the back. It's a medical emergency that requires immediate attention.
- Pneumonia: Infection in the lungs can cause chest pain, especially if it involves the pleura. It's more likely in patients with fever, cough, and shortness of breath.
Rare Diagnoses
- Pericarditis: Inflammation of the sac surrounding the heart can cause sharp chest pain that improves with sitting up and leaning forward.
- Esophageal Spasm: Abnormal contractions of the esophagus can cause chest pain that mimics cardiac issues.
- Pneumothorax: Air in the space between the lungs and chest wall can cause sudden chest pain and shortness of breath, often requiring emergency intervention.
- Costochondritis (Tietze's Syndrome): Inflammation of the cartilage that connects the ribs to the breastbone can cause chest pain and tenderness.