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

  • Acute Coronary Syndrome (ACS): This includes conditions such as myocardial infarction (MI) and unstable angina. It's the most likely diagnosis due to the high prevalence of coronary artery disease and the potential for severe outcomes if not promptly treated. Chest pain is a classic symptom, especially if it's described as a pressure or heaviness in the chest that may radiate to the arm, neck, or jaw.

• Other Likely diagnoses

  • Gastroesophageal Reflux Disease (GERD): GERD can cause chest pain that mimics cardiac issues, often described as a burning sensation. It's a common condition and should be considered, especially if the pain is related to eating or posture.
  • Musculoskeletal Pain: Strains or inflammation in the muscles or joints of the chest wall can cause pain, especially if it's localized, sharp, and reproducible with movement or palpation.
  • Pulmonary Embolism (PE): While not as common as ACS, PE is a significant cause of chest pain, especially if it's sudden, sharp, and accompanied by shortness of breath or tachypnea.
  • Pneumonia or Pleuritis: Infections or inflammation of the lung tissue or pleura can cause chest pain, typically sharp and worsened by deep breathing or coughing.

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

  • Aortic Dissection: A tear in the aorta's inner layer can cause severe, tearing chest pain that radiates to the back. It's less common but critical to diagnose promptly due to its high mortality rate.
  • Pulmonary Embolism (also listed under other likely diagnoses): Its inclusion here emphasizes the importance of not missing this diagnosis due to its potential for severe outcomes.
  • Esophageal Rupture: A rare but life-threatening condition that can cause severe chest pain, often after vomiting or retching.

• Rare diagnoses

  • Pericarditis: Inflammation of the pericardium, the sac surrounding the heart, can cause sharp chest pain that improves with sitting up and leaning forward.
  • Pneumothorax: Air in the pleural space can cause sudden, sharp chest pain and shortness of breath, more common in tall, thin individuals or those with lung disease.
  • Costochondritis (Tietze's Syndrome): Inflammation of the cartilage that connects the ribs to the breastbone can cause sharp pains, often reproducible with palpation.

Each of these diagnoses has distinct characteristics and risk factors that can guide further evaluation and management. A thorough history, physical examination, and appropriate diagnostic tests are crucial for determining the cause of chest pain.