Differential diagnosis of chest pain

1. Big picture

Chest pain is an emergency symptom until proven otherwise. In the final exam, the examiner wants you to first exclude the diagnoses that kill quickly, then separate cardiac, pulmonary, vascular, gastrointestinal, musculoskeletal, and psychogenic causes.

The safest thinking is:

Chest pain
↓
Is the patient unstable?
↓
Exclude the “big killers”
ACS / aortic dissection / pulmonary embolism / tension pneumothorax / esophageal rupture
↓
Then classify by pain character + ECG + troponin + chest imaging + targeted tests

The most important exam principle:

Do not diagnose “gastritis,” “anxiety,” or “muscle pain” before acute coronary syndrome and other life-threatening causes have been considered.

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