Chest pain differential diagnosis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1], Associate Editor(s)-in-Chief: Iqra Qamar M.D.[2]

Chest pain Microchapters
Home
Patient Information
Overview
Historical Perspective
Classification
Pathophysiology
Causes
Differentiating Chest pain from other Diseases
Epidemiology and Demographics
Risk Factors
Screening
Natural History, Complications and Prognosis
Chest Pain in Pregnancy
Diagnosis
Diagnostic Study of Choice
History and Symptoms
Physical Examination
Laboratory Findings
Electrocardiogram
X-ray
Echocardiography and Ultrasound
CT scan
MRI
Other Imaging Findings
Other Diagnostic Studies
Treatment
Medical Therapy
Interventions
Surgery
Primary Prevention
Secondary Prevention
Cost-Effectiveness of Therapy
Future or Investigational Therapies
Case Studies
Case #1
Chest pain differential diagnosis On the Web
Most recent articles
cited articles
Review articles
CME Programs
Powerpoint slides
Images
Ongoing Trials at Clinical Trials.gov
US National Guidelines Clearinghouse
NICE Guidance
FDA on Chest pain differential diagnosis
CDC on Chest pain differential diagnosis
Chest pain differential diagnosis in the news
Blogs on Chest pain differential diagnosis
to Hospitals Treating Chest pain differential diagnosis
Risk calculators and risk factors for Chest pain differential diagnosis

An expert algorithm to assist in the diagnosis of Chest pain can be found here

To go back to the main page on Unstable angina, click here

Overview

There are several life-threatening causes of chest pain which need to be evaluated for first, which include; myocardial infarction, aortic dissection, esophageal rupture, pulmonary embolism, and tension pneumothorax. The other possible causes of chest pain can be evaluated for by carefully assessing the nature of the pain, and obtaining a thorough patient history.

Differential Diagnosis

5 Life Threatening Diseases to Exclude Immediately

• Aortic dissection
• Esophageal rupture
• Myocardial infarction
• Pulmonary embolism
• Tension pneumothorax

The frequency of conditions exclusive of acute myocardial infarction in a decreasing order is:

• Gastroesophageal disease
• Ischemic heart disease (angina, not myocardial infarction)
• Chest wall syndromes

Differentiating the Life Threatening and Ischemic Causes of Chest Pain from other Disorders

Thorough history including: onset, duration, type of pain, location, exacerbating factors, alleviating factors, and radiation. Risk factors for coronary artery disease: family history, smoking, hyperlipidemia, and diabetes.

Differential Diagnosis of Chest Pain:

Differentials on the basis of Etiology	Disease	Clinical manifestations								Diagnosis
		Pain characteristics							Associated features	Lab Findings	Imaging
		Onset	Duration	Type of pain	Location	Exacerbating factors	Alleviating factors	Radiation
Cardiac	Stable Angina
	Unstable Angina
	Myocardial Infarction
	Aortic Stenosis
	Aortic Dissection
	Pericarditis
	Pericardial Tamponade
	Heart Failure
	Stress (takotsubo) Cardiomyopathy
Pulmonary	Pulmonary Embolism
	Spontaneous Pneumothorax
	Tension Pneumothorax
	Pneumonia
	Tracheitis/ Bronchitis
	Pleuritis
	Pulmonary Hypertension
	Pleural Effusion
	Asthma & COPD
	Pulmonary Malignancy
	Sarcoidosis
	Acute chest syndrome
Gastrointestinal	GERD, Peptic Ulcer
	Diffuse Esophageal Spasm
	Esophagitis
	Eosinophilic Esophagitis
	Esophageal Perforation
	Mediastinitis
	Cholelithiasis
	Pancreatitis
	Sliding Hiatal Hernia
Musculoskeletal	Rib pain
	Costosternal syndromes (costochondritis)
	Lower rib pain syndromes
	Sternalis syndrome
	Tietze's syndrome
	Xiphoidalgia
	Spontaneous sternoclavicular subluxation
	Posterior chest wall pain syndromes
Rheumatic	Fibromyalgia
	Rheumatoid arthritis
	Ankylosing spondylitis
	Psoriatic arthritis
	Sternocostoclavicular hyperostosis (SAPHO syndrome)
	Systemic lupus erythematosus
	Relapsing polychondritis
Psychiatric	Panic attack/ Disorder
	Other Psychotic disorders
Others	Substance abuse (Cocaine)
	Referred pain
	Herpes Zoster
	Domestic abuse
	Stress fracture
	Sickle cell disease