Differential diagnosis of chest pain CH:20

Cholecystitis

GI Sudden onset of pain that crescendos and can last for up to 20 min, usually post fatty meal epigastrium/right upper abdomen that can radiate to right interscapular region, shoulder, back Nausea, vomiting, anorexia, fever

Depression

Psychogenic Heaviness Chest region Fatigue, restlessness, withdrawal, weight gain or loss, depressed mood

Anxiety

Psychogenic Sharp pain Chest region Palpitations, dizziness, sweating, shaking, restlessness, fatigue, irritability

Acute coronary syndrome (ACS) (unstable angina, myocardial

Cardiovascular (Ischemic) Heaviness; viselike, squeezing, crushing, tightness; vague, burning, constricting, or pressure; poorly localized pain lasting 20-30 min to hours and doesnt resolve w rest or nitroglycerin Generalized substernal/retrosternal; can radiate to teeth, jaw, neck, one or both arms or shoulders; no pain and only associated symptoms Indigestion-like feeling, nausea, vomiting, dizziness, flushing, perspiration, palpitations, dyspnea, fatigue

Angina pectoris: stable (no change in pain pattern within last 60 days)

Cardiovascular (Ischemic) Pressure like pain: tight, squeeze, burning, heaviness lasting 3-5 min precipitated by activity and resolves w rest, nitroglycerin Generalized substernal/retrosternal; can radiate to teeth, jaw, neck, one or both arms or shoulders; no pain and only associated symptoms Diaphoresis, nausea, vomiting, dyspnea, fatigue

Prinzmetal or variant angina

Cardiovascular (Ischemic) Pressurelike discomfort often occurring at rest, unrelated to physical/emotional stress Retrosternal; can radiate to jaw, neck, left arm, shoulder Palpitations, syncope, feelings of syncope

Pulmonary HTN (secondary)

Cardiovascular (Nonischemic) Cardiac like chest pain w exertion Chest region Dyspnea, lower extremity edema, fatigue

mitral valve prolapse (MVP)

Cardiovascular (Nonischemic) Sharp pain not associated with activity Chest pain without radiation Fatigue, light headnesses, dyspnea, irregular heartbeat, palpitations, exercise intolerance

Aortic dissection

Cardiovascular (Nonischemic) Sudden severe pain w change in location and/or tearing sensation lasting for hours Anterior chest pain with radiation to the neck, jaw, interscapular region of the back Mental status changes, limb pain and weakness, dyspnea

Pericarditis

Cardiovascular (Nonischemic) Sudden sharp and stabbing pain relieved often by sitting or leaning forward and worsens by lying down or with inspiration Substernal, which can radiate to trapezius muscle region Dry cough, muscle and joint aches, fever

Herpes zoster

Dermatologic Unilateral, burning, borelike pain Chest region in dermatome distribution Tingling, itching, burning

Esophageal spasm

GI Crushing chest pain Substernal Dysphagia, sensation of object in throat/esophagus

Gastroesophageal reflux

GI May be angina-like; however, usually burning sensation with eating large meals reproduced by lying down and relieved by sitting up Retrosternal region Cough, regurgitation of food, abdominal pain

Pancreatitis

GI Sudden dull, boring, steady pain unrelieved by lying supine; leaning forward or the fetal position may ease pain epigastrium /periumbilical pain radiating to back Nausea, vomiting, anorexia, sometimes diarrhea

Chest wall muscle strain

MSK/Neurologic Sharp pain w moving, stretching or pushing movements of the arms; palpation of area reproduces the pain Area around the strained muscle, sternum, ribs Muscle spasm, crepitation, swelling, loss of strength

Costochondritis

MSK/Neurologic Sharp, pleuritic type pain worsens w deep breathing, palpation, movement Area from 2nd through 5th intercostal spaces; can radiate to arm, depending on where initial inflammation occurs Chest tightness, warmth at area of pain

Pneumonia

Pulmonary Sharp or stabbing pain associated with cough Most generalized to one side of chest but can have upper abdominal pain Cough, fever, dyspnea, chills, sputum, myalgia, malaise

Pulmonary embolism

Pulmonary Sharp, stabbing pain worsening w deep breaths Pain can be experienced in chest, back, shoulder, upper abdomen Dyspnea, hemoptysis, cough

Pneumothorax

Pulmonary acute/sudden and sharp Lateral region of the chest but can have referred pain to shoulder Acute dyspnea, cough