Chest Pain - Differential Ciagnosis Chart

Chest Pain – Differential Diagnosis Chart

Clinical Guidance

This chart provides a quick reference for differentiating common causes of chest pain. Always consider patient history, risk factors, and conduct appropriate diagnostic tests for accurate diagnosis.

Feature	Cardiac (Angina / MI)	Gastrointestinal (GERD, Esophageal spasm)	Pulmonary (PE, Pleurisy, Pneumonia)	Musculoskeletal (Costochondritis, Trauma)
Location	Sub-sternal / Retro-sternal / Mediastinum	Sub-sternal (burning, retrosternal)	Localized (lateral or pleuritic), may radiate anteriorly	Anterior chest wall (localized)
Quality	Heavy, squeezing, crushing, choking	Burning, sharp, "heartburn-like"	Sharp, stabbing, pleuritic	Aching, sharp, tender on palpation
Radiation	Neck, jaw, left shoulder, left arm, forearm, ring finger	Rare, sometimes back (esophagus)	Rare	None (localized only)
Onset	Sudden (MI) or exertional (angina)	After meals, lying flat, spicy food	Sudden (PE) or gradual (infection)	After movement, strain, trauma
Duration	Angina < 5 min, MI > 20 min	Variable (minutes–hours)	Variable (depends on cause)	Hours–days
Relation with Respiration	No relation	No relation	Worse with inspiration/cough	Worse with movement / pressure
Relief	Rest, O₂, nitrates	Antacids, proton pump inhibitors	Rest, analgesics, treatment of cause	Rest, NSAIDs, local heat
Other Clues	Sweating, nausea, palpitations, dyspnea	Acid reflux, regurgitation, sour taste	Fever, cough, dyspnea, hemoptysis (PE)	Local tenderness, reproducible pain

Key Clinical Takeaways

• Cardiac pain = retrosternal, heavy, radiating, not affected by breathing/movement.
• Gastro pain = burning, post-meal, relieved by antacids.
• Pulmonary pain = pleuritic, sharp, worse with breathing/cough.
• Musculoskeletal pain = localized, reproducible by palpation/movement.

Important Note

This chart is for educational purposes only. Always perform a thorough clinical assessment and use appropriate diagnostic tools. Cardiac causes should be ruled out first in patients with chest pain, especially those with risk factors.