Differential Diagnosis of Chest Pain: Information for Patients

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Chest pain comes in many forms and is often described as discomfort or pain that a patient feels anywhere on the front of their body between their upper abdomen and neck. Differential diagnosis is a process health care providers use to come to a definitive diagnosis, often by eliminating all other possible diseases and conditions. Making a differential diagnosis of chest pain is very extensive because so many different factors can cause this.


Musculoskeletal-related chest pain often is persistent and insidious. It is often localized to a certain area, like the midsternum or the tips of the lower ribs, and sharp. Moving the arms, breathing deeply, and turning may exacerbate the pain. These characteristics can help the health care provider determine that the patient’s chest pain is musculoskeletal in nature. A chest x-ray, blood work, or a CT scan may also be done to help narrow down the cause. Musculoskeletal-related chest pain can include:

  • Muscle strain
  • Rib cartilage inflammation
  • Fractured rib

Heart Attack

It is commonly known that chest pain is a primary sign of a heart attack. Evaluating the patients other symptoms, blood work, and risk factors can help health care providers rule out or diagnose a heart attack. In addition to chest pain, patients may experience shortness of breath, nausea or vomiting, sweating, palpitations, or dizziness.


Angina is chest discomfort or pan that occurs when the heart muscle is not getting enough blood. If an artery responsible for sending blood to the heart is narrowed, spasming, or partially blocked, this may occur. Coronary heart disease is the most common cause, followed by emotional stress, physical exertion, and arrhythmias.

Aortic Dissection

This condition occurs when the aortas’ inner layer develops a tear. Causes may include:

  • Uncontrolled high blood pressure
  • Cocaine use
  • Pregnancy
  • Cardiac catheterization
  • Connective-tissue diseases
  • Advanced cage
  • Congenital heart disease

Pulmonary Embolism

This condition is characterized by at least one artery being blocked in the lungs. Causes may include:

  • Sedentary lifestyle
  • Prolonged immobility
  • Pregnancy
  • History of blood clots, both personal and familial
  • Heart attack
  • Obesity
  • Leg bone fracture
  • Cancer
  • Arrhythmias
  • Congestive heart failure

Spontaneous Pneumothorax

This condition is simply defined as a collapsed lung. Causes may include:

  • Chest injury that leads to lung puncture
  • Excessive coughing or sneezing
  • Being very tall and thin
  • Trauma
  • AIDS-related pneumonia
  • Severe asthma
  • Cancer
  • Crack cocaine and marijuana use
  • Emphysema
  • Cystic fibrosis

Perforated Viscus

This condition is defined as an abnormal opening in an organ, specifically a hollow organ. Causes may include:

  • Injury or trauma
  • Diaphragm irritation
  • Untreated ulcers
  • Swallowing a foreign body
  • Appendicitis
  • Gallbladder infection
  • AIDS
  • Forceful or prolonged vomiting
  • Cancer
  • Long-term steroid use
  • Gallstones


This condition occurs when the pericardium becomes inflamed. Causes may include:

  • Viral or bacterial infection
  • Connective-tissue diseases
  • Radiation treatment
  • Cancer
  • Certain medications
  • Chronic renal failure


Pneumonia is simply defined as an inflammation in the lungs. Its cause can be either viral, fungal, or bacterial.


Chest pain that begins in the esophagus may be caused by a number of factors, such as:

  • Acid reflux
  • Nicotine use
  • Caffeine
  • Diabetes
  • Esophageal spasm
  • High-fat food consumption
  • Alcohol use
  • Pregnancy
  • Certain medications
  • Scleroderma
  • Esophagitis


MedlinePlus. (2010). Chest Pain. Retrieved on October 15, 2010 from MedlinePlus: https://www.nlm.nih.gov/medlineplus/ency/article/003079.htm

United States Department of Health and Human Services. (2010). Differential Diagnosis of Chest Pain. Retrieved on October 15, 2010 from the United States Department of Health and Human Services: https://www.guideline.gov/content.aspx?id=12790