Chest pain can be a symptom of various underlying conditions, ranging from benign to life-threatening. Accurate diagnosis and proper management of chest pain are crucial for ensuring appropriate treatment and preventing potential complications.

This article discusses the differential diagnosis of chest pain, highlighting the common causes and their distinctive features.

1. Acute Coronary Syndrome (ACS)

ACS refers to a group of conditions that occur due to the obstruction of blood flow to the coronary arteries, typically caused by atherosclerosis or blood clots. It includes unstable angina and myocardial infarction (heart attack).

Symptoms of ACS often include severe substernal chest pain or pressure that radiates to the left arm or jaw, shortness of breath, diaphoresis (sweating), and nausea.

2. Gastroesophageal Reflux Disease (GERD)

GERD occurs when stomach acid or bile flows back into the esophagus, causing irritation and inflammation. Chest pain associated with GERD is often described as a burning sensation that worsens after meals or when lying down.

It may be accompanied by acid regurgitation, belching, and a sour taste in the mouth.

3. Musculoskeletal Causes

Conditions affecting the musculoskeletal system can also lead to chest pain. Costochondritis, inflammation of the cartilage that connects the ribs to the breastbone, can cause sharp localized pain.

Muscle strains, fractures, or trauma to the chest wall can produce aching or sharp pain that intensifies with movement or palpation.

4. Pulmonary Embolism (PE)

PE occurs when a blood clot blocks one of the pulmonary arteries, causing reduced blood flow to the lungs.

Chest pain in PE is typically sharp, pleuritic (worsens with deep breathing), and may be associated with shortness of breath, cough, and hemoptysis (coughing up blood).

5. Pneumonia

Pneumonia is an infection that inflames the air sacs in one or both lungs. Chest pain associated with pneumonia can vary from sharp to dull, and it is often worsened by coughing or deep breathing.

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Other symptoms may include fever, productive cough, and difficulty breathing.

6. Anxiety and Panic Attacks

Psychological factors can manifest as chest pain. Anxiety and panic attacks can cause intense chest discomfort, often described as tightness or pressure. These episodes may be triggered by stress or occur suddenly without an apparent cause.

Accompanying symptoms may include palpitations, trembling, and sweating.

7. Peptic Ulcer Disease (PUD)

PUD is a condition characterized by open sores in the lining of the stomach or the upper part of the small intestine. Chest pain caused by PUD can feel similar to that of GERD, with a burning or gnawing sensation.

It may be relieved or aggravated by eating and may be associated with bloating, nausea, and weight loss.

8. Aortic Dissection

Aortic dissection occurs when there is a tear in the inner layer of the aorta, allowing blood to flow between the layers and potentially causing a life-threatening situation.

Chest pain associated with aortic dissection is often described as sudden, severe, and tearing or ripping in nature. It may radiate to the back or abdomen. Other symptoms may include unequal blood pressure in the arms, shortness of breath, and altered consciousness.

9. Esophageal Spasm

Esophageal spasms are abnormal contractions of the muscles in the esophagus, leading to chest pain or discomfort. The pain is often squeezing or cramping in nature and may be mistaken for angina.

Dysphagia (difficulty swallowing) and the sensation of food sticking in the chest may also be present.

10. Rib Fracture

A fractured rib can cause localized chest pain that worsens with deep breathing or movement. The affected area may be tender to touch, and there may be visible swelling or bruising.

Rib fractures often occur due to trauma, such as a fall or direct blow to the chest.