Differential Diagnosis for Chest Pain
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 ischemia but is usually accompanied by other symptoms like heartburn and regurgitation.
Other Likely Diagnoses
- Musculoskeletal Pain: Chest wall pain from strained muscles or costochondritis is common and can be diagnosed based on tenderness to palpation and movement.
- Asthma or Chronic Obstructive Pulmonary Disease (COPD) Exacerbation: These conditions can cause chest tightness or pain, especially if associated with wheezing, cough, or shortness of breath.
- Pulmonary Embolism: While less common than other causes, pulmonary embolism should be considered, especially in patients with risk factors like recent travel, surgery, or family history of clotting disorders.
- Pneumonia: Infection of the lung can cause pleuritic chest pain, which worsens with deep breathing or coughing.
Do Not Miss Diagnoses
- Myocardial Infarction (MI): Although not the most common cause, MI is potentially fatal and requires immediate intervention. Risk factors include hypertension, diabetes, high cholesterol, smoking, and family history of heart disease.
- Aortic Dissection: A life-threatening condition where the inner layer of the aorta tears, causing severe, tearing chest pain that radiates to the back. It's more common in patients with hypertension or aortic aneurysm.
- Pulmonary Embolism (mentioned earlier but also belongs here): Due to its potential for being fatal if missed, it's crucial to consider PE in any patient with unexplained chest pain, especially with risk factors.
Rare Diagnoses
- Esophageal Spasm or Rupture: These conditions can cause severe chest pain but are less common. Esophageal rupture is a medical emergency.
- Pericarditis: Inflammation of the pericardium, the sac surrounding the heart, can cause sharp chest pain that improves with leaning forward.
- Pneumothorax: Air in the pleural space can cause sudden, severe chest pain and shortness of breath, more common in tall, thin males or those with lung disease.