Differential Diagnosis for Burning Chest Pain
Single Most Likely Diagnosis
- Gastroesophageal Reflux Disease (GERD): The symptoms of burning chest pain, particularly at night and in the morning, are classic for GERD. The fact that Tums (an antacid) did not provide relief does not entirely rule out GERD, as it may require more potent acid suppression or other treatments.
Other Likely Diagnoses
- Costochondritis: Inflammation of the cartilage that connects the ribs to the breastbone can cause sharp, stabbing pains that may worsen at night or with movement. The pain's location under the left breast and its stabbing nature could suggest costochondritis.
- Musculoskeletal Pain: Strained muscles or inflammation in the chest wall can cause pain that feels like it's coming from the breast area. This could be due to overuse, poor posture, or other mechanical issues.
- Precordial Catch Syndrome: A condition characterized by sharp, stabbing pains in the chest that can occur at any time, including at night. It's often related to the muscles or nerves in the chest wall.
Do Not Miss Diagnoses
- Acute Coronary Syndrome (ACS): Although less likely given the description of the pain and the patient's response to Tums, ACS (including myocardial infarction) must be considered, especially if the patient has risk factors for heart disease. The pain of ACS can sometimes be atypical, especially in women.
- Pulmonary Embolism (PE): Sudden onset of chest pain, especially if it's sharp and stabbing, could indicate a PE, particularly if accompanied by other symptoms like shortness of breath or cough.
- Esophageal Spasm or Esophageal Rupture: These conditions can cause severe, sudden chest pain and are medical emergencies.
Rare Diagnoses
- Tietze's Syndrome: A rare condition similar to costochondritis but involves the inflammation of the cartilages and surrounding tissues in the chest wall.
- Sickle Cell Crisis: In patients with sickle cell disease, a crisis can cause severe chest pain due to vaso-occlusion in the lungs or chest wall.
- Herpes Zoster (Shingles): Before the rash appears, shingles can cause severe, burning pain in a dermatomal distribution, which could be mistaken for other causes of chest pain.