Chest Pain Differential

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Chest Pain

Non-cardiac

MSK

Pain may be reproducible on physical exam

No burning in esophagus

Psychological

Anxiety/panic attack

Also associated with breathlessness, palpitations, weakness, and anxiety

Aggravated by emotional stress

Stabbing, sticking, or dull and aching pain located precordial, below left breast, or across anterior chest

Esophageal

Visceral hyperalgesia

Also associated with constipation, bloating, diarrhea, and nausea/vomiting

Not normally associated with eating or lying down

Pain presentation ranges from sharp to dull or burning and may be constant or relapsing

Achalasia

Food is coming from esophagus, not stomach

Associated with dysphagia, regurgitation of food and liquids, coughing at night, and chest pain that comes and goes

GERD

Pulmonary

Tracheobronchitis

Associated with a cough

May be relieved by lying on affected side

Made worse by coughing, not food or lying down

Burning pain located upper sternal or on either side of sternum

Pleuritic pain

Persistent pain aggravated by deep inspiration, coughing, and movements of the trunk

Sharp, knife-like pain located on chest wall

Cardiac

Dissecting Aortic Aneurysm

Also associated with hoarseness, dysphagia, syncope, hemiplegia, and paraplegia

Aggravated by hypertension, not food or lying down

Would be an abrupt onset, early peak, and persist for hours or more

Ripping, tearing pain located on anterior chest and radiating to neck, back, or abdomen

Pericarditis

Sharp, knife-like or crushing pain located retrosternal or left precordial and may radiate to tip of left

Angina Pectoris/MI

Sometimes associated with dyspnea, nausea, sweating, weakness

Not persistent and at the same time (each night, after each meal)

Not normally associated with eating meals, beer, coffee, or lying down

Pressing or squeezing pain (not usually burning) located retrosternal or across anterior chest and sometimes radiating to shoulders, arms, neck, lower jaw, or upper abdomen