Differential Diagnosis for Chest Tightness

• Single most likely diagnosis
  • Acute Coronary Syndrome (ACS): This is often the first consideration for chest tightness due to its potential severity and the need for immediate intervention. Justification: ACS, including myocardial infarction, is a common cause of chest tightness or pressure and requires urgent medical attention.
• Other Likely diagnoses
  • Gastroesophageal Reflux Disease (GERD): Chest tightness can be a symptom of GERD, especially if it occurs after eating or at night. Justification: The symptoms of GERD can mimic those of cardiac issues, making it a plausible differential diagnosis for chest tightness.
  • Anxiety or Panic Disorder: These conditions can cause chest tightness or discomfort. Justification: Anxiety and panic disorders are common and can manifest with physical symptoms, including chest tightness, making them likely considerations.
  • Musculoskeletal Pain: Strain or injury to the muscles of the chest wall can cause tightness. Justification: Given the frequency of musculoskeletal injuries, this is a reasonable differential diagnosis for chest tightness, especially if there's a history of trauma or overuse.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
  • Pulmonary Embolism (PE): Although less common, PE is a life-threatening condition that can cause chest tightness, especially if it occurs with shortness of breath or tachycardia. Justification: The potential for high mortality if untreated makes PE a critical diagnosis not to miss.
  • Aortic Dissection: This is a rare but life-threatening condition that can cause severe chest pain or tightness. Justification: Given its high mortality rate if not promptly treated, aortic dissection must be considered in the differential diagnosis of chest tightness.
  • Pneumothorax: A collapsed lung can cause chest tightness along with shortness of breath. Justification: Pneumothorax is a medical emergency that requires immediate attention, making it a "do not miss" diagnosis.
• Rare diagnoses
  • Pericarditis: Inflammation of the pericardium can cause chest pain or tightness. Justification: While less common, pericarditis is a potential cause of chest tightness and should be considered, especially if accompanied by a pericardial friction rub.
  • Esophageal Spasm: Spasms of the esophagus can cause chest tightness or pain. Justification: This is a less common condition but can mimic more serious cardiac or pulmonary issues, making it a rare but possible differential diagnosis.