Differential Diagnosis for Chest Pain

The following is a differential diagnosis for chest pain, categorized for clarity and emphasis on potential severity.

• Single most likely diagnosis

  • Acute Coronary Syndrome (ACS): This is often the first consideration for chest pain due to its high prevalence and potential for severe outcomes. Justification: ACS, including myocardial infarction, is a common cause of chest pain and has significant morbidity and mortality if not promptly treated.

• Other Likely diagnoses

  • Gastroesophageal Reflux Disease (GERD): Chest pain can be a symptom of GERD, especially if it worsens with eating or lying down. Justification: GERD is common and can cause chest pain that may mimic cardiac issues.
  • Musculoskeletal Pain: Strain or inflammation of the muscles or joints in the chest wall can cause pain. Justification: This is a common and often benign cause of chest pain, especially if related to recent physical activity or trauma.
  • Pulmonary Embolism (PE): While less common than ACS, PE is a significant cause of chest pain, especially in patients with risk factors for thromboembolism. Justification: PE can present with sudden onset chest pain and is critical to diagnose early due to its high mortality rate if untreated.
  • Pneumonia or Pleuritis: Infection or inflammation of the lung tissue or lining can cause chest pain, especially if it worsens with deep breathing. Justification: These conditions are relatively common and can be severe, especially in vulnerable populations like the elderly or immunocompromised.

• Do Not Miss diagnoses

  • Aortic Dissection: A life-threatening condition where the inner layer of the aorta tears, causing severe, tearing chest pain. Justification: Although rare, aortic dissection has a very high mortality rate if not promptly diagnosed and treated.
  • Pulmonary Embolism (also listed under Other Likely diagnoses due to its relatively higher likelihood but included here for emphasis on not missing the diagnosis): Justification: The potential for high mortality if missed warrants its inclusion in both categories.
  • Esophageal Rupture: A rare but potentially fatal condition where the esophagus tears, often due to severe vomiting. Justification: Early diagnosis is crucial for survival, making it a "do not miss" diagnosis.

• Rare diagnoses

  • Pericarditis: Inflammation of the sac surrounding the heart, which can cause chest pain that improves with leaning forward. Justification: While not as common as other causes, pericarditis can be a significant cause of chest pain and has specific treatments.
  • Pneumothorax: Collapse of the lung due to air in the chest cavity, which can cause sudden chest pain and shortness of breath. Justification: Although less common, pneumothorax is a medical emergency requiring prompt intervention.
  • Costochondritis (Tietze's syndrome): Inflammation of the cartilage that connects the ribs to the breastbone, causing chest pain. Justification: This condition is relatively rare and often benign but can be confused with more serious conditions.