Differential Diagnosis for Intermittent Exertional Chest Tightness
Single Most Likely Diagnosis
- Angina Pectoris: This is the most likely diagnosis due to the classic presentation of chest tightness during exertion, which is a hallmark symptom of myocardial ischemia. The pain is typically relieved by rest.
Other Likely Diagnoses
- Asthma: Exertional asthma can cause chest tightness, especially if the patient has a history of asthma or atopy. The symptoms can be similar to angina but are usually accompanied by wheezing and shortness of breath.
- Gastroesophageal Reflux Disease (GERD): GERD can cause chest discomfort or tightness, especially after eating or during exertion, due to acid reflux into the esophagus.
- Musculoskeletal Pain: Chest wall pain or costochondritis can cause exertional chest tightness, especially if the pain is reproducible with palpation or movement of the chest wall.
Do Not Miss Diagnoses
- Acute Coronary Syndrome (ACS): Although angina is the most likely diagnosis, it's crucial not to miss ACS, which includes conditions like myocardial infarction (MI). ACS can present similarly to angina but is a medical emergency.
- Pulmonary Embolism (PE): PE can cause sudden onset of chest pain or tightness, especially with exertion, and is a life-threatening condition that requires immediate diagnosis and treatment.
- Aortic Dissection: This is a rare but deadly condition that can cause severe, tearing chest pain, which may be exertional. It requires immediate medical attention.
Rare Diagnoses
- Hypertrophic Cardiomyopathy: This condition can cause exertional chest pain or tightness due to outflow tract obstruction, but it is less common and typically associated with other symptoms like syncope or palpitations.
- Pericarditis: Inflammation of the pericardium can cause chest pain that may be exertional and is usually accompanied by a pericardial friction rub.
- Pneumothorax: A spontaneous pneumothorax can cause sudden onset of chest pain or tightness, especially with exertion, and is more common in tall, thin males or those with underlying lung disease.