Differential Diagnosis for Chest Pressure
- Single most likely diagnosis:
- Acute Coronary Syndrome (ACS): This is the most likely diagnosis due to the high prevalence of coronary artery disease and the potential for life-threatening complications if not promptly treated. Chest pressure is a classic symptom of ACS, which includes conditions such as myocardial infarction (MI) and unstable angina.
- Other Likely diagnoses:
- Gastroesophageal Reflux Disease (GERD): GERD can cause chest pressure or discomfort, especially after eating or at night, due to the reflux of stomach acid into the esophagus.
- Musculoskeletal Pain: Chest wall pain or costochondritis can cause sharp or dull chest pressure, often related to movement or position.
- Pulmonary Embolism (PE): While less common than ACS, PE is a significant cause of chest pressure, especially in patients with risk factors such as recent surgery, immobilization, or cancer.
- Pneumonia or Pleuritis: Infections or inflammation of the lung or pleura can cause chest pressure, often accompanied by cough, fever, or shortness of breath.
- Do Not Miss diagnoses:
- Aortic Dissection: A life-threatening condition where the inner layer of the aorta tears, causing severe chest pain or pressure that can radiate to the back.
- Pulmonary Hypertension: Elevated blood pressure in the pulmonary arteries can cause chest pressure, especially with exertion, and is associated with significant morbidity and mortality if not treated.
- Cardiac Tamponade: Fluid accumulation in the pericardial sac can compress the heart, leading to chest pressure, decreased cardiac output, and potentially fatal outcomes if not promptly addressed.
- Rare diagnoses:
- Esophageal Spasm or Rupture: Rare conditions that can cause severe chest pressure, often accompanied by difficulty swallowing or severe pain.
- Hypertrophic Cardiomyopathy: A genetic condition that can cause the heart muscle to thicken, leading to chest pressure or pain, especially with exertion.
- Pericarditis: Inflammation of the pericardium can cause sharp chest pain or pressure, often improving with leaning forward.