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 considered a common cause of chest pain due to its high prevalence and the fact that its symptoms can mimic more serious conditions, such as cardiac issues. The pain associated with GERD can be burning and is typically exacerbated by lying down or eating certain foods.

• Other Likely diagnoses:

  • Musculoskeletal pain: This includes conditions like costochondritis (inflammation of the cartilage that connects the ribs to the breastbone) or muscle strain, which can cause chest pain that may be sharp and localized.
  • Asthma or chronic obstructive pulmonary disease (COPD): These respiratory conditions can cause chest pain or discomfort, especially during exacerbations or when breathing becomes more difficult.
  • Pneumonia or pleuritis: Infections or inflammation of the lung tissue or the lining around the lungs can cause sharp chest pain that worsens with deep breathing or coughing.

• Do Not Miss (ddxs that may not be likely, but would be deadly if missed):

  • Myocardial infarction (heart attack): Although not the most common cause of chest pain, it is critical to rule out due to its high mortality rate if not promptly treated. The pain is often described as a heavy or squeezing sensation in the chest.
  • Pulmonary embolism: A blood clot in the lungs can cause sudden, severe chest pain and is life-threatening. It often presents with shortness of breath and may be associated with recent travel, surgery, or immobility.
  • Aortic dissection: A tear in the aorta's inner layer can cause severe, tearing chest pain and is immediately life-threatening. It may radiate to the back and is more common in individuals with hypertension or aortic aneurysm.
  • Pericarditis: Inflammation of the sac surrounding the heart can cause sharp chest pain that may improve with leaning forward. It can be associated with fever and a pericardial friction rub on examination.

• Rare diagnoses:

  • Esophageal rupture or perforation: A severe condition that can cause sudden, severe chest pain and is often associated with difficulty swallowing or vomiting.
  • Pneumothorax: Air in the space between the lungs and chest cavity can cause sudden chest pain and shortness of breath, especially if it is a large pneumothorax.
  • Mediastinitis: Inflammation of the tissues in the mediastinum (the area between the lungs) can cause chest pain and is often associated with infection or recent surgery.

Each of these diagnoses has distinct characteristics and risk factors, and a thorough medical history, physical examination, and diagnostic tests are crucial for an accurate diagnosis and appropriate management of chest pain.