Chest Pain Differential Diagnosis

The differential diagnosis for chest pain is extensive and can be categorized into several groups. Here's a breakdown of the possible causes:

• Single Most Likely Diagnosis

  • Gastroesophageal Reflux Disease (GERD): This is often the most common cause of chest pain, especially if the pain is related to eating or relieved by antacids. The pain can mimic cardiac issues but is usually accompanied by other symptoms like heartburn and regurgitation.

• Other Likely Diagnoses

  • Musculoskeletal Pain: Strains or inflammation in the muscles or joints of the chest wall can cause significant pain. This type of pain often worsens with movement or deep breathing.
  • Asthma or Chronic Obstructive Pulmonary Disease (COPD) Exacerbation: Respiratory conditions can lead to chest pain, especially if there's associated wheezing, coughing, or shortness of breath.
  • 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.
  • Pericarditis: Inflammation of the sac surrounding the heart can cause sharp, stabbing chest pain that may improve with leaning forward.

• Do Not Miss Diagnoses

  • Myocardial Infarction (MI): A heart attack is a medical emergency that requires immediate attention. The pain is typically described as a heavy, squeezing sensation in the center of the chest that may radiate to the arms, back, neck, jaw, or stomach.
  • Pulmonary Embolism (PE): A blood clot in the lungs can cause sudden, severe chest pain that worsens with deep breathing, along with shortness of breath and possibly coughing up blood.
  • Aortic Dissection: A tear in the aorta's inner layer can cause severe, tearing chest pain that radiates to the back. This condition is life-threatening and requires immediate medical intervention.
  • Esophageal Rupture: A tear in the esophagus can lead to severe chest pain, often accompanied by difficulty swallowing, vomiting, and severe pain that worsens over time.

• Rare Diagnoses

  • Pneumothorax: Air in the space between the lungs and chest wall can cause sudden, severe chest pain and shortness of breath.
  • Costochondritis (Tietze's Syndrome): Inflammation of the cartilage that connects the ribs to the breastbone can cause sharp chest pain.
  • Mitral Valve Prolapse: A condition where the valve between the heart's chambers doesn't close properly, potentially leading to chest pain, though it's more commonly associated with palpitations and shortness of breath.
  • Hypertrophic Cardiomyopathy: A condition where the heart muscle becomes abnormally thick, which can lead to chest pain, especially during exertion, due to the heart's reduced ability to pump blood efficiently.