Differential Diagnosis for Chest Pain
Single Most Likely Diagnosis
- Acute Coronary Syndrome (ACS): This is often the first consideration in patients presenting with chest pain, especially if the pain is described as squeezing, pressure, or heaviness, and is associated with exertion or stress. The justification for this being the single most likely diagnosis is based on the high prevalence of coronary artery disease in the general population and the potential for serious outcomes if not promptly addressed.
Other Likely Diagnoses
- Gastroesophageal Reflux Disease (GERD): Chest pain that is burning in nature and associated with eating or relieved by antacids could suggest GERD. This condition is common and can mimic cardiac chest pain.
- Pulmonary Embolism (PE): Sudden onset of chest pain that worsens with deep breathing, associated with shortness of breath, could indicate a pulmonary embolism. This condition, while less common than ACS, is a significant consideration due to its potential severity.
- Musculoskeletal Pain: Chest pain that is sharp, localized to a specific area, and reproducible with movement or palpation may be musculoskeletal in origin. This is a common cause of chest pain, especially in younger patients without cardiovascular risk factors.
Do Not Miss Diagnoses
- Aortic Dissection: Severe, tearing chest pain that radiates to the back is highly suggestive of an aortic dissection. This condition is life-threatening and requires immediate intervention.
- Pneumothorax: Sudden onset of sharp chest pain and shortness of breath could indicate a pneumothorax, especially in tall, thin males or those with underlying lung disease. This condition can lead to respiratory compromise if not promptly treated.
- Pericarditis: Chest pain that is sharp, improves with sitting up and leaning forward, and is associated with a pericardial friction rub on examination, suggests pericarditis. While often less severe than other conditions, pericarditis can lead to cardiac tamponade, a life-threatening complication.
Rare Diagnoses
- Esophageal Rupture: Severe, constant chest pain associated with difficulty swallowing and possibly vomiting, especially after forceful vomiting or eating, could indicate an esophageal rupture. This is a rare but serious condition requiring immediate surgical intervention.
- Pulmonary Artery Hypertension: Progressive shortness of breath and chest pain, especially with exertion, in a patient with risk factors such as connective tissue disease, could suggest pulmonary artery hypertension. This condition is rare but has significant implications for morbidity and mortality.
- Chest Wall Tumors: Localized chest pain with a palpable mass could indicate a chest wall tumor. These are rare and often have a more insidious onset than other causes of chest pain.