Chest pain DDx

Overview

The approach to non-traumatic chest pain requires the early recognition and exclusion of potential life threats, then further consideration of other causes.

Causes

Potentially life-threatening causes of chest pain

Cardiovascular

• Acute coronary syndromes (STE-ACS and NSTE-ACS)
• Aortic dissection
• Myocarditis (most common cause of sudden death in the young)
• Pericarditis
• Cardiac Tamponade
• Pulmonary embolism
• Cardiac valve disease e.g. aortic stenosis, mitral stenosis, mitral valve prolapse
• Stress Cardiomyopathies e.g. Takotsubo

Other

• Tension pneumothorax
• Acute chest syndrome (in sickle cell disease)
• Boerhaave syndrome (perforated oesophagus)

Common non-life-threatening causes of chest pain

Gastrointestinal

• Biliary colic
• Gastroesophageal reflux
• Peptic ulcer disease

Pulmonary

• Pneumonia
• Pleurisy

Chest wall syndromes

• Musculoskeletal pain
• Costochondritis
• Thoracic radiculopathy
• Bornholm disease (Acute, transient viral myositis associated with Coxsackie B)
• Tietze syndrome (Idiopathic benign inflammation of one or more of the costal cartilages)
• Texidor twinge (precordial catch syndrome)
• Mondor disease

Psychiatric

• Anxiety
• Somatisation
• Da Costa syndrome (Symptom-complex characterized by palpitation, dyspnea, precordial pain, fatigue, exaggerated emotional responses with increased cardiac awareness)

Occult trauma

• rib fractures

Infection

• Shingles

CCC Differential Diagnosis Series
NEURO	Anosmia, Ataxia, Blepharospasm, Bulbar and Pseudobulbar palsy, Central Pontine Myelinosis, Cerebellar Disease, Chorea, Cranial nerve lesions, Dementia, Dystonia, Exophthalmos, Eye trauma, Facial twitches, Fixed dilated pupil, Horner syndrome, Loss of vision, Meningism, Movement disorders, Optic disc abnormality, Parkinsonism, Peripheral neuropathy, Radiculopathy, Red eye, Retinal Haemorrhage, Seizures, Sudden severe headache, Tremor, Tunnel vision
RESP	Bronchial breath sounds, Bronchiectasis, High airway pressures, Massive haemoptysis, Sore throat, Tracheal displacement
CVS	Atrial Fibrillation, Bradycardia, Cardiac Failure, Chest Pain, Murmurs, Post-resuscitation syndrome, Pulseless Electrical Activity (PEA), Pulsus Paradoxus, Shock, Supraventricular tachycardia (SVT), Tachycardia, VT and VF, SVC Obstruction
GIT	Abdominal distension, Abdominal mass, Abdominal pain, Asterixis, Dysphagia, Hepatomegaly, Hepatosplenomegaly, Large bowel obstruction, Liver palpation abnormalities, Lower GI haemorrhage, Malabsorption, Medical causes of abdominal pain, Rectal mass, Small bowel obstruction, Upper GI Haemorrhage
GUT	Genital ulcers, Groin lump, Scrotal mass, Urine colour, Urine Odour, Urine transparency,
MSK	Arthritis, Shoulder pain, Wasting of the small muscles of the hand
DERM	Palmar erythema, Serious skin signs in sick patients, Thickened Tethered Skin, Leg ulcers, Skin Tumour, Acanthosis Nigricans
ENDO	Diabetes Insipidus, Diffuse Goitre, Gynaecomastia, Hirsutism, Hypoglycaemia, SIADH, Weight Loss
HAEM	Splenomegaly
PAEDS	Floppy infant
MISC	Anaphylaxis, Autoimmune associated diseases, Clubbing, Parotid Swelling, Splinter haemorrhages, Toxic agents and abnormal vitals, Toxicological causes of cardiac arrest
IMAGING	CHEST: Atelectasis, Hilar adenopathy, Hilar enlargement on CXR, Honeycomb lung, Increased interstitial markings, Mediastinal widening on mobile CXR, Pulmonary fibrosis, Pseudoinfiltrates on CXR, Pulmonary opacities on CXR, ABDO: Gas on abdominal X-ray, Kidney mass, BRAIN: Intracranial calcification, Intracranial structures with contrast, Ventriculomegaly, OTHER: Pseudofracture on X-Ray,
LABS	LOW: Anaemia, Hypocalcaemia, hypochloraemia, Hypomagnesaemia,  HIGH: Bilirubin and Jaundice, Hyperammonaemia, Hypercalcaemia, Hyperchloraemia, Hyperkalaemia, Hypermagnesaemia,  ACID BASE: Acid base disorders, Resp. acidosis, Resp. alkalosis, Creatinine, CRP, Dipstick Urinalysis, Laboratory Urinalysis, Liver function tests (LFTs), Pleural fluid analysis, Urea, Urea Creatinine Ratio, Uric acid, Urinalysis, Urine Electrolytes

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