Differential Diagnosis for Chest Pain

Single Most Likely Diagnosis

• Acute Coronary Syndrome (ACS): This is often the first consideration in patients presenting with chest pain, especially if the pain is described as pressure-like, radiates to the arm, neck, or jaw, and is associated with shortness of breath, diaphoresis, or nausea. The high prevalence and potential for severe outcomes make ACS a top priority.

Other Likely Diagnoses

• Pulmonary Embolism (PE): Sudden onset of chest pain that worsens with deep breathing, accompanied by symptoms like tachypnea, tachycardia, or signs of DVT, should raise suspicion for PE.
• Pneumonia: Chest pain that is pleuritic (sharp, worsens with breathing) along with fever, cough, and possibly sputum production, points towards pneumonia.
• Gastroesophageal Reflux Disease (GERD): Burning chest pain that improves with antacids or is related to eating, lying down, or certain foods, suggests GERD.
• Musculoskeletal Pain: Chest pain that is sharp, localized, and reproducible with palpation or movement, is often musculoskeletal in nature.

Do Not Miss Diagnoses

• Aortic Dissection: Severe, tearing chest pain that radiates to the back, with a significant difference in blood pressure between arms, or signs of cardiac tamponade, should prompt immediate consideration of aortic dissection.
• Pulmonary Embolism (also listed under likely, but critical as a "do not miss"): Given its potential for high mortality if untreated, PE must always be considered, especially in patients with risk factors like recent travel, surgery, cancer, or immobilization.
• Esophageal Rupture: Severe, constant chest pain after vomiting or eating, with signs of sepsis, indicates a potential esophageal rupture, which is a medical emergency.

Rare Diagnoses

• Pericarditis: Sharp, pleuritic chest pain that improves with leaning forward, accompanied by a pericardial friction rub, suggests pericarditis.
• Pneumothorax: Sudden onset of sharp chest pain and shortness of breath, especially in a tall, thin male or in the context of trauma, should raise suspicion for pneumothorax.
• Myocarditis: Chest pain with signs of heart failure, arrhythmias, or elevated cardiac biomarkers in the absence of coronary artery disease, might indicate myocarditis.

Each of these diagnoses requires careful consideration based on the patient's presentation, history, and risk factors to ensure accurate and timely management.