Chest pain

• Differential diagnosis

  Cardiovascular:

  • Acute coronary syndrome
  • Angina
  • Aortic dissection.
  • Arrhythmia
  • Valve disease
  • Acute pericarditis (pleuritic).
  • Cardiac tamponade.
  • Stress (Takotsubo) cardiomyopathy.

  Pleuritic chest pain i.e. pain on inspiration, is a sign of pleural inflammation. Caused by:

  • Pneumonia
  • PE
  • Pneumothorax
  • Pericarditis
  • Viral pleurisy.
  • Lung cancer.
  • Pleural effusion.

  GI:

  • GORD: commonest non-cardiovascular cause.
  • Peptic ulcer disease.
  • Gallstones
  • Pancreatitis

  Other:

  • Musculoskeletal: trauma, costochondritis.
  • Anxiety: panic attack.
  • Functional: chest wall syndrome.
  • Shingles. Pain may come before rash.