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 high prevalence of coronary artery disease in the general population and the potential for serious outcomes if not promptly treated make ACS a leading diagnosis.
Other Likely Diagnoses
- Gastroesophageal Reflux Disease (GERD): Chest pain that is burning in nature, worsens with lying down, and is associated with regurgitation or a sour taste can suggest GERD. This condition is common and can mimic cardiac chest pain.
- Musculoskeletal Pain: Chest wall pain, which can be sharp and localized, often reproduced by movement or pressure on the chest wall, is a common cause of chest pain. The musculoskeletal system is a frequent source of pain due to its widespread nature and the variety of activities that can strain it.
- Pulmonary Embolism (PE): While not as common as ACS, PE is an important consideration, especially in patients with risk factors such as recent travel, immobilization, cancer, or a history of deep vein thrombosis. The pain associated with PE is often sharp and stabbing, and may be accompanied by shortness of breath.
- Pneumonia or Pleuritis: Infections like pneumonia can cause chest pain, typically sharp and worsened by deep breathing or coughing. The presence of fever, cough, or shortness of breath can guide towards this diagnosis.
Do Not Miss Diagnoses
- Aortic Dissection: A life-threatening condition characterized by severe, tearing chest pain that radiates to the back. It requires immediate recognition and treatment. Risk factors include hypertension, aortic aneurysm, and certain genetic conditions.
- Pulmonary Embolism (also listed under Other Likely Diagnoses): Due to its potential for high mortality if not treated promptly, PE is also a "do not miss" diagnosis.
- Esophageal Rupture: Severe, constant chest pain associated with difficulty swallowing, vomiting, or severe epigastric pain can indicate an esophageal rupture, which is a medical emergency.
Rare Diagnoses
- Pericarditis: Inflammation of the pericardium, which can cause sharp, stabbing chest pain that improves with sitting up and leaning forward. It is less common but can be associated with viral infections, autoimmune diseases, or post-myocardial infarction.
- Pneumothorax: Collapse of the lung, which can cause sudden, sharp chest pain and shortness of breath. It is more common in tall, thin males or those with underlying lung disease.
- Costochondritis (Tietze's Syndrome): Inflammation of the cartilage that connects the ribs to the breastbone, causing sharp pains in the chest. It is relatively rare and can be confused with cardiac conditions.