Chest pain: Differential Diagnosis

Question 1

Life-threatening - Diff Dx:

Answer 1

1. Acute myocardial infarction
2. Angina/acute coronary syndrome *
3. Aortic dissection
4. Tension pneumothorax
5. Pulmonary embolism
6. Oesophageal rupture

Question 2

Others - Diff Dx:

Answer 2

1. Pneumonia
2. Chest wall pain: Muscular/ Rib fractures/ Bony metastases/ Costochondritis
3. Gastro-oesophageal reflux
4. Pleurisy
5. Empyema
6. Pericarditis
7. Oesophageal spasm
8. Herpes zoster
9. Cervical spondylosis
10. Intra-abdominal: Cholecystitis/ Peptic ulceration/ Pancreatitis
11. Sickle-cell crisis

Question 3

Fts of cardiac chest pain:

Answer 3

1. Pain is usually dull
2. May radiate to jaw, arm, or epigastrium
3. Usually associated with exertion

Question 4

Fts of cardiac chest pain:

Answer 4

1. Pain is usually dull
2. May radiate to jaw, arm, or epigastrium
3. Usually associated with exertion

Question 5

Key investigations:

Answer 5

1. ECG
2. CXR
3. FBC, U&E, and troponin
4. Consider D-dimer