Chest pain DDx

Chest pain – Differential Diagnosis

Common causes

• Musculoskeletal pain
• Costochondritis
• GORD
• Oesophageal spasm
• Peptic ulcer disease
• Anxiety
• Medically unexplained symp’

Must Not Miss

• Vascular
  • Myocardial Infarction
  • Angina
  • Pulmonary embolism
  • Dissecting aortic aneurysm
  • Pericarditis
• Pneumonia
• Pneumothorax
• Lung cancer
• Oesophageal cancer
• Spinal cord compression

Easily missed

• Biliary colic
• Herpes Zoster
• Rib fracture

Red flags

• Acute onset severe pain
• Exercise related pain
• Prolonged pain > 15 minutes
• Associated features
  • Nausea, vomiting and sweating
  • Tachycardia
  • Dyspnoea
  • Haemoptysis
  • Syncope
  • Weight loss
  • Neurological symptoms

Investigations to consider

• FBC, CRP/ESR, D-dimer
• U+Es, LFTs, TFTs, Serum glucose/lipids
• Cardiac enzymes
• ECG
• Exercise tolerance test
• Echocardiography
• CXR
• CT scan
• V/Q scan
• Pulmonary angiography
• USS
• Upper GI endoscopy
• Oesophageal manometry