Chest Pain Differential Diagnosis

The differential diagnosis for chest pain is broad and can be categorized into several groups. Here's a breakdown of the potential 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 associated with regurgitation or a burning sensation.

• Other Likely Diagnoses

  • Musculoskeletal Pain: Strains or inflammation of the muscles and joints in the chest wall can cause significant pain, often reproducible by movement or pressure.
  • Asthma or Chronic Obstructive Pulmonary Disease (COPD) Exacerbation: These conditions can cause chest tightness or pain, especially during episodes of wheezing or shortness of breath.
  • Pneumonia or Pulmonary Embolism: While less common than GERD or musculoskeletal issues, these are significant causes of chest pain that can be associated with respiratory symptoms like cough or shortness of breath.
  • Pericarditis: Inflammation of the pericardium, the sac surrounding the heart, can cause sharp chest pain that may improve with leaning forward.

• Do Not Miss Diagnoses

  • Myocardial Infarction (MI): Although not the most common cause, MI is a critical diagnosis to consider due to its high morbidity and mortality. The pain is typically described as a heavy or squeezing sensation in the chest.
  • Aortic Dissection: A tear in the aorta's inner layer can cause severe, tearing chest pain that radiates to the back. It's a medical emergency.
  • Pulmonary Embolism: While mentioned in other likely diagnoses, it's crucial enough to be highlighted here due to its potential for being fatal if missed.

• Rare Diagnoses

  • Esophageal Spasm or Rupture: These conditions can cause severe chest pain but are less common. Esophageal rupture is a medical emergency.
  • Pneumothorax: Air in the pleural space can cause sudden, sharp chest pain and shortness of breath, more common in tall, thin males or those with lung disease.
  • Costochondritis (Tietze's Syndrome): Inflammation of the cartilage that connects the ribs to the breastbone can cause chest pain, often confused with cardiac issues.

Each of these diagnoses has distinct characteristics and risk factors, and a thorough history, physical examination, and diagnostic tests are essential for an accurate diagnosis.