Chest pain differential diagnosis

Jump to navigation Jump to search


Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1], Associate Editor(s)-in-Chief: Iqra Qamar M.D.[2] Amresh Kumar MD [3]

Chest pain Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Chest pain from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Chest Pain in Pregnancy

Diagnosis

Diagnostic Study of Choice

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

X-ray

Echocardiography and Ultrasound

CT scan

MRI

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Interventions

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Chest pain differential diagnosis On the Web

Most recent articles

cited articles

Review articles

CME Programs

Powerpoint slides

Images

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Chest pain differential diagnosis

CDC on Chest pain differential diagnosis

Chest pain differential diagnosis in the news

Blogs on Chest pain differential diagnosis

to Hospitals Treating Chest pain differential diagnosis

Risk calculators and risk factors for Chest pain differential diagnosis

An expert algorithm to assist in the diagnosis of Chest pain can be found here

To go back to the main page on Unstable angina, click here

Overview

There are several life-threatening causes of chest pain which need to be evaluated for first, which include; myocardial infarction, aortic dissection, esophageal rupture, pulmonary embolism, and tension pneumothorax. The other possible causes of chest pain can be evaluated for by carefully assessing the nature of the pain, and obtaining a thorough patient history.

Differential Diagnosis

5 Life Threatening Diseases to Exclude Immediately

The frequency of conditions exclusive of acute myocardial infarction in a decreasing order is:[9]

Differentiating the Life Threatening and Ischemic Causes of Chest Pain from other Disorders

Thorough history including: onset, duration, type of pain, location, exacerbating factors, alleviating factors, and radiation. Risk factors for coronary artery disease: family history, smoking, hyperlipidemia, and diabetes.

Differential Diagnosis of Chest Pain:

When a patient presents with chest pain, the following differentials mentioned in the table below need to be ruled out to reach the appropriate diagnosis.[10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45]

Abbreviations: ABG (arterial blood gas); ACE (angiotensin converting enzyme); BMI (body mass index); CBC (complete blood count); CSF (cerebrospinal fluid); CXR (chest X-ray); ECG (electrocardiogram); FEF (forced expiratory flow rate); FEV1 (forced expiratory volume); FVC (forced vital capacity); JVD (jugular vein distention); MCV (mean corpuscular volume); Plt (platelet); RV (residual volume); SIADH (syndrome of inappropriate antidiuretic hormone); TSH (thyroid stimulating hormone); Vt (tidal volume); WBC (white blood cell); 20 minutes | style="background: #F5F5F5; padding: 5px;" |

  • Same as stable angina but often more severe

| style="background: #F5F5F5; padding: 5px;" | - | style="background: #F5F5F5; padding: 5px;" | - | style="background: #F5F5F5; padding: 5px;" | + | style="background: #F5F5F5; padding: 5px;" | - | style="background: #F5F5F5; padding: 5px;" |

| style="background: #F5F5F5; padding: 5px;" |

| style="background: #F5F5F5; padding: 5px;" |

| style="background: #F5F5F5; padding: 5px;" |

  • ST elevation MI (STEMI)
  • Non-ST elevation MI (NSTEMI) or Non Q wave

| style="background: #F5F5F5; padding: 5px;" |

  • Echocardiography
  • Coronary angiography
  • Multidetector computed tomography (MDCT) coronary angiography
  • Myocardial perfusion imaging (MPI) with single-photon emission CT (SPECT) or positron emission tomography (PET) scanning

| style="background: #F5F5F5; padding: 5px;" |

  • Elevated cardiac biomarkers [Cardiac troponin I, cardiac troponin T)

|- style="background: #DCDCDC; padding: 5px; text-align: center;" | |Aortic Stenosis | style="background: #F5F5F5; padding: 5px;" |Acute, recurrent episodes of angina | style="background: #F5F5F5; padding: 5px;" |2-10 minutes | style="background: #F5F5F5; padding: 5px;" |

  • Heaviness/pressure/ tightness/squeezing/ burning (Levine's sign)
  • Retrosternal

| style="background: #F5F5F5; padding: 5px;" | - | style="background: #F5F5F5; padding: 5px;" | - | style="background: #F5F5F5; padding: 5px;" | + | style="background: #F5F5F5; padding: 5px;" | - | style="background: #F5F5F5; padding: 5px;" |

| style="background: #F5F5F5; padding: 5px;" |

| style="background: #F5F5F5; padding: 5px;" |

  • Peripheral blood smear may show schistiocytes

| style="background: #F5F5F5; padding: 5px;" |

  • Non specific (the voltage of the QRS complex is increased showing the presence of left ventricular hypertrophy)

| style="background: #F5F5F5; padding: 5px;" |

  • CXR
  • Echocardiography
  • Cardiac Catheterization and Coronary Arteriography
  • Radionuclide Ventriculography

| style="background: #F5F5F5; padding: 5px;" |

    • Transthoracic Echo

|- style="background: #DCDCDC; padding: 5px; text-align: center;" | |Aortic Dissection | style="background: #F5F5F5; padding: 5px;" |Sudden severe progressive pain (common) or chronic (rare) | style="background: #F5F5F5; padding: 5px;" |Variable | style="background: #F5F5F5; padding: 5px;" |

  • Tearing, ripping sensation, knife like

| style="background: #F5F5F5; padding: 5px;" | - | style="background: #F5F5F5; padding: 5px;" | - | style="background: #F5F5F5; padding: 5px;" | + | style="background: #F5F5F5; padding: 5px;" | - | style="background: #F5F5F5; padding: 5px;" |

| style="background: #F5F5F5; padding: 5px;" |

| style="background: #F5F5F5; padding: 5px;" |

| style="background: #F5F5F5; padding: 5px;" |

  • Nonspecific ST and T wave changes

| style="background: #F5F5F5; padding: 5px;" |

  • CXR: Mediastinal and/or aortic widening
  • CTA
  • MRA
  • TEE

| style="background: #F5F5F5; padding: 5px;" |

  • MRI

|- style="background: #DCDCDC; padding: 5px; text-align: center;" | |Pericarditis | style="background: #F5F5F5; padding: 5px;" |Acute or subacute | style="background: #F5F5F5; padding: 5px;" |May last for hours to days | style="background: #F5F5F5; padding: 5px;" |

  • Sharp & localized retrosternal pain

| style="background: #F5F5F5; padding: 5px;" | + | style="background: #F5F5F5; padding: 5px;" | + | style="background: #F5F5F5; padding: 5px;" | + | style="background: #F5F5F5; padding: 5px;" | - | style="background: #F5F5F5; padding: 5px;" |

| style="background: #F5F5F5; padding: 5px;" |

| style="background: #F5F5F5; padding: 5px;" |

| style="background: #F5F5F5; padding: 5px;" |

  • EKG changes (typically widespread ST segment elevation or PR depressions)

| style="background: #F5F5F5; padding: 5px;" |

  • Chest x-ray typically normal
  • Echocardiogram: normal or pericardial effusion
  • CT scan: Noncalcified pericardial thickening with pericardial effusion
  • CMR: inflamed pericardium and myocarditis

| style="background: #F5F5F5; padding: 5px;" |

  • Pericardiocentesis
  • Pericardial biopsy

|- style="background: #DCDCDC; padding: 5px; text-align: center;" | |Pericardial Tamponade | style="background: #F5F5F5; padding: 5px;" |Acute or subacute | style="background: #F5F5F5; padding: 5px;" |May last for hours to days | style="background: #F5F5F5; padding: 5px;" |

  • Sharp and stabbing retrosternal pain

| style="background: #F5F5F5; padding: 5px;" | +/- | style="background: #F5F5F5; padding: 5px;" | + | style="background: #F5F5F5; padding: 5px;" | + | style="background: #F5F5F5; padding: 5px;" | - | style="background: #F5F5F5; padding: 5px;" |

| style="background: #F5F5F5; padding: 5px;" |

| style="background: #F5F5F5; padding: 5px;" |

| style="background: #F5F5F5; padding: 5px;" |EKG findings:

  • Sinus tachycardia
  • Low QRS voltage
  • Electrical alternans

| style="background: #F5F5F5; padding: 5px;" |

  • CXR: enlarged cardiac silhouette with clear lung fields
  • Echocardiography: Chamber collapse, Respiratory variation in volumes and flows, IVC plethora
  • Swan-Ganz Catheterization: Equilibration of average intracardiac diastolic pressures (usually between 10 and 30 mmHg) 

| style="background: #F5F5F5; padding: 5px;" |

  • Echocardiography

|- style="background: #DCDCDC; padding: 5px; text-align: center;" | |Heart Failure | style="background: #F5F5F5; padding: 5px;" |Subacute or chronic | style="background: #F5F5F5; padding: 5px;" |Variable | style="background: #F5F5F5; padding: 5px;" |

  • Dull
  • Left sided chest pain

| style="background: #F5F5F5; padding: 5px;" | + | style="background: #F5F5F5; padding: 5px;" | - | style="background: #F5F5F5; padding: 5px;" | + | style="background: #F5F5F5; padding: 5px;" | - | style="background: #F5F5F5; padding: 5px;" |

| style="background: #F5F5F5; padding: 5px;" |

| style="background: #F5F5F5; padding: 5px;" |

| style="background: #F5F5F5; padding: 5px;" |

  • EKG findings are specific according to each cause of heart failure

| style="background: #F5F5F5; padding: 5px;" |

  • CXR: Cardiomegaly
  • Radionuclide multiple-gated acquisition scanning
  • Electrocardiogram-gated myocardial perfusion imaging
  • Equilibrium radionuclide angiocardiography
  • Catheterization and Angiography

| style="background: #F5F5F5; padding: 5px;" |

  • Echocardiography

|- style="background: #DCDCDC; padding: 5px; text-align: center;" | |Stress (takotsubo) Cardiomyopathy | style="background: #F5F5F5; padding: 5px;" |Acute | style="background: #F5F5F5; padding: 5px;" |Commonly > 20 minutes | style="background: #F5F5F5; padding: 5px;" |

  • Substernal heaviness or tightness

| style="background: #F5F5F5; padding: 5px;" | - | style="background: #F5F5F5; padding: 5px;" | - | style="background: #F5F5F5; padding: 5px;" | + | style="background: #F5F5F5; padding: 5px;" | - | style="background: #F5F5F5; padding: 5px;" |

  • Setting of physical or emotional stress or critical illness

| style="background: #F5F5F5; padding: 5px;" |

| style="background: #F5F5F5; padding: 5px;" |

| style="background: #F5F5F5; padding: 5px;" |

  • ST segment elevation
  • ST depression
  • QT interval prolongation, T wave inversion, abnormal Q waves

| style="background: #F5F5F5; padding: 5px;" |

  • Radionuclide myocardial perfusion imaging 

| style="background: #F5F5F5; padding: 5px;" |

  • Ventriculography and invasive coronary angiography

|- style="background: #4479BA; color: #FFFFFF; text-align: center;" ! rowspan="3" |Differentials on the basis of Etiology ! rowspan="3" |Disease ! colspan="9" |Clinical manifestations ! colspan="4" |Diagnosis |- style="background: #4479BA; color: #FFFFFF; text-align: center;" | colspan="8" |Symptoms ! rowspan="2" |Physical exam ! rowspan="2" |Lab Findings ! rowspan="2" |EKG ! rowspan="2" |Imaging ! rowspan="2" |Gold standard |- style="background: #4479BA; color: #FFFFFF; text-align: center;" !Onset !Duration !Type of Pain !Cough !Fever !Dyspnea !Weight loss !Associated Features |- style="background: #DCDCDC; padding: 5px; text-align: center;" | ! rowspan="12" |Pulmonary |Pulmonary Embolism | style="background: #F5F5F5; padding: 5px;" |Acute | style="background: #F5F5F5; padding: 5px;" |May last minutes to hours | style="background: #F5F5F5; padding: 5px;" |

  • Sharp or knifelike or pleuritic pain
  • Localized to side of lesion

| style="background: #F5F5F5; padding: 5px;" | + | style="background: #F5F5F5; padding: 5px;" | +/- | style="background: #F5F5F5; padding: 5px;" | + | style="background: #F5F5F5; padding: 5px;" | - | style="background: #F5F5F5; padding: 5px;" |

| style="background: #F5F5F5; padding: 5px;" |

| style="background: #F5F5F5; padding: 5px;" |

| style="background: #F5F5F5; padding: 5px;" |

  • Tachycardia and nonspecific ST-segment and T-wave changes (70 percent)
  • S1Q3T3 pattern
  • New right bundle branch block
  • Inferior Q-waves (leads II, III, and aVF)

| style="background: #F5F5F5; padding: 5px;" |

  • Duplex Ultrasonography
  • Echocardiography
  • Venography
  • Ventilation-Perfusion Scanning

| style="background: #F5F5F5; padding: 5px;" |

  • CT pulmonary angiography

|- style="background: #DCDCDC; padding: 5px; text-align: center;" | |Spontaneous Pneumothorax | style="background: #F5F5F5; padding: 5px;" |Acute | style="background: #F5F5F5; padding: 5px;" |May last minutes to hours | style="background: #F5F5F5; padding: 5px;" |

  • Sharp
  • Localized pleuritic

| style="background: #F5F5F5; padding: 5px;" | - | style="background: #F5F5F5; padding: 5px;" | - | style="background: #F5F5F5; padding: 5px;" | + | style="background: #F5F5F5; padding: 5px;" | - | style="background: #F5F5F5; padding: 5px;" |

| style="background: #F5F5F5; padding: 5px;" |

| style="background: #F5F5F5; padding: 5px;" |

  • Respiratory alkalosis on ABGs

| style="background: #F5F5F5; padding: 5px;" |

  • Rightward shift in the mean electrical axis
  • Loss of precordial R waves
  • Diminution of the QRS voltage
  • Precordial T wave inversions

| style="background: #F5F5F5; padding: 5px;" |

  • CXR: White visceral pleural line on the chest radiograph
  • Contrast-Enhanced Esophagography
  • Computed Tomography of Chest

| style="background: #F5F5F5; padding: 5px;" |

  • CT scan

|- | style="background: #DCDCDC; padding: 5px; text-align: center;" |Tension Pneumothorax | style="background: #F5F5F5; padding: 5px;" |Acute | style="background: #F5F5F5; padding: 5px;" |May last minutes to hours | style="background: #F5F5F5; padding: 5px;" |

  • Sharp
  • Pleuritic

| style="background: #F5F5F5; padding: 5px;" | - | style="background: #F5F5F5; padding: 5px;" | - | style="background: #F5F5F5; padding: 5px;" | + | style="background: #F5F5F5; padding: 5px;" | - | style="background: #F5F5F5; padding: 5px;" |

| style="background: #F5F5F5; padding: 5px;" |

| style="background: #F5F5F5; padding: 5px;" |

| style="background: #F5F5F5; padding: 5px;" |

  • Significant elevation of the ST-T segment from leads V1 to V4

| style="background: #F5F5F5; padding: 5px;" |

  • CXR: White visceral pleural line on the chest radiograph
  • Ultrasonography
  • Computed Tomography of Chest

| style="background: #F5F5F5; padding: 5px;" |

  • CT scan

|- style="background: #DCDCDC; padding: 5px; text-align: center;" | |Pneumonia | style="background: #F5F5F5; padding: 5px;" |Acute or chronic | style="background: #F5F5F5; padding: 5px;" |Variable | style="background: #F5F5F5; padding: 5px;" |

  • Dull
  • Localized to side of lesion

| style="background: #F5F5F5; padding: 5px;" | + | style="background: #F5F5F5; padding: 5px;" | + | style="background: #F5F5F5; padding: 5px;" | + | style="background: #F5F5F5; padding: 5px;" | +/- | style="background: #F5F5F5; padding: 5px;" |

| style="background: #F5F5F5; padding: 5px;" |

| style="background: #F5F5F5; padding: 5px;" |

| style="background: #F5F5F5; padding: 5px;" |

  • Sinus tachycardia
  • Nonspecific ST-segment or T-wave changes

| style="background: #F5F5F5; padding: 5px;" |

  • CXR: lung infiltrates
  • Chest CT Scanning
  • Bronchoscopy with or without BAL

| style="background: #F5F5F5; padding: 5px;" |

  • Presence of lung infiltrates on CXR
  • Blood cultures

|- style="background: #DCDCDC; padding: 5px; text-align: center;" | |Tracheitis/ Bronchitis | style="background: #F5F5F5; padding: 5px;" |Acute | style="background: #F5F5F5; padding: 5px;" |Variable | style="background: #F5F5F5; padding: 5px;" |

  • Dull
  • Substernal

| style="background: #F5F5F5; padding: 5px;" | + | style="background: #F5F5F5; padding: 5px;" | + | style="background: #F5F5F5; padding: 5px;" | + | style="background: #F5F5F5; padding: 5px;" | - | style="background: #F5F5F5; padding: 5px;" |

| style="background: #F5F5F5; padding: 5px;" |

| style="background: #F5F5F5; padding: 5px;" |

| style="background: #F5F5F5; padding: 5px;" |

  • Peaked P-wave

| style="background: #F5F5F5; padding: 5px;" |

  • Radiography of the neck
  • Laryngotracheobronchoscopy

| style="background: #F5F5F5; padding: 5px;" |

  • Bronchoscopy

|- style="background: #DCDCDC; padding: 5px; text-align: center;" | |Pleuritis | style="background: #F5F5F5; padding: 5px;" |Acute or subacute or chronic | style="background: #F5F5F5; padding: 5px;" |May last minutes to hours | style="background: #F5F5F5; padding: 5px;" |

  • Sharp
  • Localized pleuritic

| style="background: #F5F5F5; padding: 5px;" | + | style="background: #F5F5F5; padding: 5px;" | + | style="background: #F5F5F5; padding: 5px;" | + | style="background: #F5F5F5; padding: 5px;" | - | style="background: #F5F5F5; padding: 5px;" |

| style="background: #F5F5F5; padding: 5px;" |

| style="background: #F5F5F5; padding: 5px;" |

| style="background: #F5F5F5; padding: 5px;" |

  • EKG done to rule out other causes in differential diagnoses

| style="background: #F5F5F5; padding: 5px;" |

  • Chest X Ray
  • Computerized tomography (CT) scan
  • Ultrasound

| style="background: #F5F5F5; padding: 5px;" |

  • Video assisted thoracoscopic surgery

|- style="background: #DCDCDC; padding: 5px; text-align: center;" | |Pulmonary Hypertension | style="background: #F5F5F5; padding: 5px;" |Acute or subacute or chronic | style="background: #F5F5F5; padding: 5px;" |Variable | style="background: #F5F5F5; padding: 5px;" |

  • Substernal pressure like

| style="background: #F5F5F5; padding: 5px;" | + | style="background: #F5F5F5; padding: 5px;" | - | style="background: #F5F5F5; padding: 5px;" | + | style="background: #F5F5F5; padding: 5px;" | - | style="background: #F5F5F5; padding: 5px;" |

| style="background: #F5F5F5; padding: 5px;" |

| style="background: #F5F5F5; padding: 5px;" |

| style="background: #F5F5F5; padding: 5px;" |

  • Right axis deviation
  • An R wave/S wave ratio greater than one in lead V1
  • Incomplete or complete right bundle branch block
  • Increased P wave amplitude in lead II (P pulmonale) due to right atrial enlargement 

| style="background: #F5F5F5; padding: 5px;" |

  • Chest Radiography
  • Echocardiography
  • Ventilation-Perfusion Lung Scanning
  • Right-Sided Cardiac Catheterization

| style="background: #F5F5F5; padding: 5px;" |

  • Cardiac catheterization

|- style="background: #DCDCDC; padding: 5px; text-align: center;" | |Pleural Effusion | style="background: #F5F5F5; padding: 5px;" |Acute or subacute or chronic | style="background: #F5F5F5; padding: 5px;" |Variable | style="background: #F5F5F5; padding: 5px;" |

  • Dull
  • Pleuritic pain

| style="background: #F5F5F5; padding: 5px;" | + | style="background: #F5F5F5; padding: 5px;" | +/- | style="background: #F5F5F5; padding: 5px;" | + | style="background: #F5F5F5; padding: 5px;" | +/- | style="background: #F5F5F5; padding: 5px;" |

| style="background: #F5F5F5; padding: 5px;" |

| style="background: #F5F5F5; padding: 5px;" |

| style="background: #F5F5F5; padding: 5px;" |

  • Typically not indicated

| style="background: #F5F5F5; padding: 5px;" |

  • CT Scanning
  • Ultrasonography
  • Chest Radiography
  • Diagnostic Thoracentesis
  • Pleural biopsy

| style="background: #F5F5F5; padding: 5px;" |

  • Computed tomography

|- style="background: #DCDCDC; padding: 5px; text-align: center;" | |Asthma & COPD | style="background: #F5F5F5; padding: 5px;" |Acute or subacute or chronic | style="background: #F5F5F5; padding: 5px;" |Variable | style="background: #F5F5F5; padding: 5px;" |

  • Tightness

| style="background: #F5F5F5; padding: 5px;" | + | style="background: #F5F5F5; padding: 5px;" | +/- | style="background: #F5F5F5; padding: 5px;" | + | style="background: #F5F5F5; padding: 5px;" | +/- | style="background: #F5F5F5; padding: 5px;" |

| style="background: #F5F5F5; padding: 5px;" |

| style="background: #F5F5F5; padding: 5px;" |

| style="background: #F5F5F5; padding: 5px;" |

  • Peaked P-wave
  • Reduced amplitude of the QRS complexes
  • Multifocal atrial tachycardia (MAT)

| style="background: #F5F5F5; padding: 5px;" |

  • Chest Radiography
  • Chest CT Scanning
  • Electrocardiography
  • MRI
  • Nuclear Imaging

| style="background: #F5F5F5; padding: 5px;" |

  • Spirometry

|- style="background: #DCDCDC; padding: 5px; text-align: center;" | |Pulmonary Malignancy | style="background: #F5F5F5; padding: 5px;" |Chronic | style="background: #F5F5F5; padding: 5px;" |Week to months | style="background: #F5F5F5; padding: 5px;" |

  • Dull aching

| style="background: #F5F5F5; padding: 5px;" | + | style="background: #F5F5F5; padding: 5px;" | +/- | style="background: #F5F5F5; padding: 5px;" | + | style="background: #F5F5F5; padding: 5px;" | + | style="background: #F5F5F5; padding: 5px;" |

| style="background: #F5F5F5; padding: 5px;" |

| style="background: #F5F5F5; padding: 5px;" |

| style="background: #F5F5F5; padding: 5px;" |

  • EKG may be performed before cancer treatment to identify any pre-existing conditions, or during treatment to check for possible heart damage

| style="background: #F5F5F5; padding: 5px;" |

  • Chest radiography
  • CT scanning of the chest and abdomen
  • Endobronchial ultrasound (EBUS)
  • Endoscopic ultrasound
  • CT scanning/magnetic resonance imaging (MRI) of the brain with IV contrast
  • Bone scanning

| style="background: #F5F5F5; padding: 5px;" |

  • CT Scan

|- style="background: #DCDCDC; padding: 5px; text-align: center;" | |Sarcoidosis | style="background: #F5F5F5; padding: 5px;" |Chronic | style="background: #F5F5F5; padding: 5px;" |Days to week | style="background: #F5F5F5; padding: 5px;" |

  • Chest fullness

| style="background: #F5F5F5; padding: 5px;" | + | style="background: #F5F5F5; padding: 5px;" | - | style="background: #F5F5F5; padding: 5px;" | + | style="background: #F5F5F5; padding: 5px;" | - | style="background: #F5F5F5; padding: 5px;" |

| style="background: #F5F5F5; padding: 5px;" |

  • Not any significant auscultatory finding

| style="background: #F5F5F5; padding: 5px;" |

| style="background: #F5F5F5; padding: 5px;" |

  • AV block
  • Prolongation of the PR interval (first-degree AV block)
  • Ventricular arrhythmias (sustained or nonsustained ventricular tachycardia and ventricular premature beats [VPBs]) 
  • Supraventricular arrhythmias

| style="background: #F5F5F5; padding: 5px;" |

  • Chest radiograph
  • Pulmonary function tests
  • High-resolution CT (HRCT) scanning of the chest

| style="background: #F5F5F5; padding: 5px;" |

  • Lung Biopsy

|- style="background: #DCDCDC; padding: 5px; text-align: center;" | |Acute chest syndrome (Sickle cell anemia) | style="background: #F5F5F5; padding: 5px;" |Acute | style="background: #F5F5F5; padding: 5px;" |May last minutes to hours | style="background: #F5F5F5; padding: 5px;" |

  • Chest tightness

| style="background: #F5F5F5; padding: 5px;" | + | style="background: #F5F5F5; padding: 5px;" | +/- | style="background: #F5F5F5; padding: 5px;" | + | style="background: #F5F5F5; padding: 5px;" | - | style="background: #F5F5F5; padding: 5px;" |

| style="background: #F5F5F5; padding: 5px;" |

| style="background: #F5F5F5; padding: 5px;" |

| style="background: #F5F5F5; padding: 5px;" |

  • EKG typically not indicated

| style="background: #F5F5F5; padding: 5px;" |

  • Chest radiography
  • Plain radiography of the extremities
  • Magnetic Resonance Imaging
  • Computed Tomography
  • Nuclear Medicine Scans
  • Transcranial Doppler Ultrasonography
  • Abdominal Ultrasonography
  • Echocardiography

| style="background: #F5F5F5; padding: 5px;" |

  • No any gold standard test for acute chest syndrome

|- style="background: #4479BA; color: #FFFFFF; text-align: center;" ! rowspan="3" |Differentials on the basis of Etiology ! rowspan="3" |Disease ! colspan="9" |Clinical manifestations ! colspan="4" |Diagnosis |- style="background: #4479BA; color: #FFFFFF; text-align: center;" | colspan="8" |Symptoms ! rowspan="2" |Physical exam ! rowspan="2" |Lab Findings ! rowspan="2" |EKG ! rowspan="2" |Imaging ! rowspan="2" |Gold standard |- style="background: #4479BA; color: #FFFFFF; text-align: center;" !Onset !Duration !Type of Pain !Cough !Fever !Dyspnea !Weight loss !Associated Features |- style="background: #DCDCDC; padding: 5px; text-align: center;" | | rowspan="9" |Gastrointestinal |GERD, Peptic Ulcer | style="background: #F5F5F5; padding: 5px;" |Acute | style="background: #F5F5F5; padding: 5px;" |

| style="background: #F5F5F5; padding: 5px;" |

| style="background: #F5F5F5; padding: 5px;" | +/- | style="background: #F5F5F5; padding: 5px;" | - | style="background: #F5F5F5; padding: 5px;" | - | style="background: #F5F5F5; padding: 5px;" | +/- | style="background: #F5F5F5; padding: 5px;" |

| style="background: #F5F5F5; padding: 5px;" |

  • Not any auscultatory findings associated with this disease

| style="background: #F5F5F5; padding: 5px;" |

  • Serum Gastrin Level
  • Secretin Stimulation Test
  • Ambulatory 24-Hour pH Monitoring

| style="background: #F5F5F5; padding: 5px;" |

  • An electrocardiogram (ECG) can show T wave inversions in leads V2 through V4 consistent with myocardial ischemia in patients with peptic ulcer perforation

| style="background: #F5F5F5; padding: 5px;" |

  • Upper Gastrointestinal Endoscopy
  • Esophageal Manometry
  • Barium esophagogram 
  • Ambulatory reflux monitoring
  • Nuclear Medicine Gastric Emptying Study
  • Intraluminal Esophageal Electrical Impedance

| style="background: #F5F5F5; padding: 5px;" |

  • Ambulatory pH monitoring

|- style="background: #DCDCDC; padding: 5px; text-align: center;" | |Diffuse Esophageal Spasm | style="background: #F5F5F5; padding: 5px;" |Acute | style="background: #F5F5F5; padding: 5px;" |

  • Minutes to hours

| style="background: #F5F5F5; padding: 5px;" |

  • Burning
  • Pressure
  • Retrosternal

| style="background: #F5F5F5; padding: 5px;" | + | style="background: #F5F5F5; padding: 5px;" | - | style="background: #F5F5F5; padding: 5px;" | +/- | style="background: #F5F5F5; padding: 5px;" |

  • Not specific

| style="background: #F5F5F5; padding: 5px;" |

| style="background: #F5F5F5; padding: 5px;" |

| style="background: #F5F5F5; padding: 5px;" |

  • No ECG findings associated with DES, but ECG is done to exclude variant angina due to higher concurrent association of variant angina with DES 

| style="background: #F5F5F5; padding: 5px;" |

  • Barium swallow
  • Esophageal manometry is more than 20% premature contractions
  • CT scanning
  • Ultrasonography

| style="background: #F5F5F5; padding: 5px;" |

  • Esophageal manometry

| style="background: #F5F5F5; padding: 5px;" |--- |- style="background: #DCDCDC; padding: 5px; text-align: center;" | |Esophagitis | style="background: #F5F5F5; padding: 5px;" |Acute | style="background: #F5F5F5; padding: 5px;" |Variable | style="background: #F5F5F5; padding: 5px;" |

| style="background: #F5F5F5; padding: 5px;" | + | style="background: #F5F5F5; padding: 5px;" | + | style="background: #F5F5F5; padding: 5px;" | - | style="background: #F5F5F5; padding: 5px;" | +/- | style="background: #F5F5F5; padding: 5px;" |

| style="background: #F5F5F5; padding: 5px;" |

  • No auscultatory finding in the this disease

| style="background: #F5F5F5; padding: 5px;" |

| style="background: #F5F5F5; padding: 5px;" |

  • ECG is done to rule out acute coronary syndrome for the cause of chest pain

| style="background: #F5F5F5; padding: 5px;" |

  • Double-contrast esophageal barium study (esophagography)
  • Endoscopy

| style="background: #F5F5F5; padding: 5px;" |

  • Biopsy

|- style="background: #DCDCDC; padding: 5px; text-align: center;" | |Eosinophilic Esophagitis | style="background: #F5F5F5; padding: 5px;" |Chronic | style="background: #F5F5F5; padding: 5px;" |Variable | style="background: #F5F5F5; padding: 5px;" |

  • Burning
  • Retrosternal
  • Abdominal

| style="background: #F5F5F5; padding: 5px;" | + | style="background: #F5F5F5; padding: 5px;" | - | style="background: #F5F5F5; padding: 5px;" | - | style="background: #F5F5F5; padding: 5px;" | - | style="background: #F5F5F5; padding: 5px;" |

| style="background: #F5F5F5; padding: 5px;" |

  • No auscultatory finding in the this disease

| style="background: #F5F5F5; padding: 5px;" |

  • Elevated IgE
  • Elevated peripheral eosinophils
  • Skin prick testing
  • Blood allergy testing
  • Atopy patch testing

| style="background: #F5F5F5; padding: 5px;" |

  • Typically no finding on EKG

| style="background: #F5F5F5; padding: 5px;" |

  • Barium studies
  • Endoscopy
  • CT scan
  • MRI

| style="background: #F5F5F5; padding: 5px;" |

|- style="background: #DCDCDC; padding: 5px; text-align: center;" | |Esophageal Perforation[15] | style="background: #F5F5F5; padding: 5px;" |Acute | style="background: #F5F5F5; padding: 5px;" |Minutes to hours | style="background: #F5F5F5; padding: 5px;" |

  • Burning
  • Upper abdominal

| style="background: #F5F5F5; padding: 5px;" | - | style="background: #F5F5F5; padding: 5px;" | +/- | style="background: #F5F5F5; padding: 5px;" | + | style="background: #F5F5F5; padding: 5px;" | - | style="background: #F5F5F5; padding: 5px;" |

| style="background: #F5F5F5; padding: 5px;" |

| style="background: #F5F5F5; padding: 5px;" |

  • CBC
  • Serum albumin levels
  • Thoracentesis with examination of the pleural fluid

| style="background: #F5F5F5; padding: 5px;" |

| style="background: #F5F5F5; padding: 5px;" |

  • Water-soluble contrast esophagram

| style="background: #F5F5F5; padding: 5px;" |

  • Iodine, water-soluble contrast medium esophagography

|- style="background: #DCDCDC; padding: 5px; text-align: center;" | |Mediastinitis | style="background: #F5F5F5; padding: 5px;" |Acute, Chronic | style="background: #F5F5F5; padding: 5px;" |Variable | style="background: #F5F5F5; padding: 5px;" |

  • Retrosternal irritation

| style="background: #F5F5F5; padding: 5px;" | +/- | style="background: #F5F5F5; padding: 5px;" | + | style="background: #F5F5F5; padding: 5px;" | + | style="background: #F5F5F5; padding: 5px;" | - | style="background: #F5F5F5; padding: 5px;" |

  • Nonspecific

| style="background: #F5F5F5; padding: 5px;" |

  • Crunching sound heard with a stethoscope over the precordium during systole called as Hamman sign

| style="background: #F5F5F5; padding: 5px;" |

  • Positive organisms in sternal culture
  • Complete blood count (CBC)
  • Blood cultures

| style="background: #F5F5F5; padding: 5px;" |

  • Diffuse ST elevation

| style="background: #F5F5F5; padding: 5px;" |

  • CT
  • Chest X-Ray
  • Magnetic resonance imaging
  • Nuclear medicine

| style="background: #F5F5F5; padding: 5px;" |

  • No any gold standard test for this disease yet

|- style="background: #DCDCDC; padding: 5px; text-align: center;" | | Cholelithiasis | style="background: #F5F5F5; padding: 5px;" |Acute, subacute | style="background: #F5F5F5; padding: 5px;" |Minutes to hours | style="background: #F5F5F5; padding: 5px;" |

| style="background: #F5F5F5; padding: 5px;" | - | style="background: #F5F5F5; padding: 5px;" | +/- | style="background: #F5F5F5; padding: 5px;" | - | style="background: #F5F5F5; padding: 5px;" |

| style="background: #F5F5F5; padding: 5px;" |

  • No auscultatory finding associated with this disease

| style="background: #F5F5F5; padding: 5px;" |

  • LFT's
  • Amylase levels
  • Llipase levels
  • CBC

| style="background: #F5F5F5; padding: 5px;" |

  • Typically not indicated

| style="background: #F5F5F5; padding: 5px;" |

  • Transabdominal ultrasound (TAUS)
  • Abdominal Radiography
  • CT Scan
  • Magnetic resonance imaging (MRI) with magnetic resonance cholangiopancreatography (MRCP)
  • Scintigraphy
  • Endoscopic Retrograde Cholangiopancreatography (ERCP)
  • Percutaneous Transhepatic Cholangiography (PTC)

| style="background: #F5F5F5; padding: 5px;" |

  • Ultrasound

|- style="background: #DCDCDC; padding: 5px; text-align: center;" | |Pancreatitis | style="background: #F5F5F5; padding: 5px;" |Acute, Chronic | style="background: #F5F5F5; padding: 5px;" |Variable | style="background: #F5F5F5; padding: 5px;" |

| style="background: #F5F5F5; padding: 5px;" | - | style="background: #F5F5F5; padding: 5px;" | + | style="background: #F5F5F5; padding: 5px;" | + | style="background: #F5F5F5; padding: 5px;" | +/- | style="background: #F5F5F5; padding: 5px;" |

| style="background: #F5F5F5; padding: 5px;" |

  • No auscultatory finding associated with this disease

| style="background: #F5F5F5; padding: 5px;" |

  • Amylase levels
  • Lipase levels 
  • Fecal tests
  • LFT's
  • Serum electrolytes
  • BUN and creatinine
  • Blood glucose, cholesterol, and triglycerides levels
  • CBC
  • C-reactive protein

| style="background: #F5F5F5; padding: 5px;" |

  • T-wave inversion
  • ST-segment depression
  •  ST-segment elevation rarely
  • Q-waves

| style="background: #F5F5F5; padding: 5px;" |

  • CT
  • MRI
  • Transabdominal ultrasound ((TAUS)
  • Abdominal radiography
  • Endoscopic Retrograde Cholangiopancreatography
  • Magnetic Resonance Cholangiopancreatography
  • Image-Guided Aspiration and Drainage

| style="background: #F5F5F5; padding: 5px;" |

  • CT Scan

|- style="background: #DCDCDC; padding: 5px; text-align: center;" | |Sliding Hiatal Hernia | style="background: #F5F5F5; padding: 5px;" |Acute | style="background: #F5F5F5; padding: 5px;" |Variable | style="background: #F5F5F5; padding: 5px;" |

| style="background: #F5F5F5; padding: 5px;" | + | style="background: #F5F5F5; padding: 5px;" | - | style="background: #F5F5F5; padding: 5px;" | + | style="background: #F5F5F5; padding: 5px;" | - | style="background: #F5F5F5; padding: 5px;" |

| style="background: #F5F5F5; padding: 5px;" |

  • No auscultatory finding associated with this disease

| style="background: #F5F5F5; padding: 5px;" |

  • No any specific laboratory test is done

| style="background: #F5F5F5; padding: 5px;" |

  • T wave inversion in anterior lead.

| style="background: #F5F5F5; padding: 5px;" |

| style="background: #F5F5F5; padding: 5px;" |

  • Endoscopy

|- style="background: #DCDCDC; padding: 5px; text-align: center;" | | rowspan="6" |Musculoskeletal |Costosternal syndromes (costochondritis) | style="background: #F5F5F5; padding: 5px;" |Acute, subacute | style="background: #F5F5F5; padding: 5px;" |Days to weeks | style="background: #F5F5F5; padding: 5px;" |

  • Pressure like on anterior part of chest wall

| style="background: #F5F5F5; padding: 5px;" | - | style="background: #F5F5F5; padding: 5px;" | + | style="background: #F5F5F5; padding: 5px;" | - | style="background: #F5F5F5; padding: 5px;" |

  • Chest wall pain occurs with a history of repeated minor trauma or unaccustomed activity (eg, painting, moving furniture) 

| style="background: #F5F5F5; padding: 5px;" |

| style="background: #F5F5F5; padding: 5px;" |

  • No specific diagnostic test for this disease
  • The workup is done for excluding cardiac disorders and other causes of chest pain

| style="background: #F5F5F5; padding: 5px;" |

  • EKG is done to rule out other cardiovascular causes

| style="background: #F5F5F5; padding: 5px;" |

  • CXR
  • MRI

| style="background: #F5F5F5; padding: 5px;" |

  • No any gold standard test for this disease

|- style="background: #DCDCDC; padding: 5px; text-align: center;" | |Lower rib pain syndromes | style="background: #F5F5F5; padding: 5px;" |Chronic | style="background: #F5F5F5; padding: 5px;" |Variable | style="background: #F5F5F5; padding: 5px;" |

  • Aching
  • Lower chest
  • Upper abdomen

| style="background: #F5F5F5; padding: 5px;" | - | style="background: #F5F5F5; padding: 5px;" | - | style="background: #F5F5F5; padding: 5px;" | + | style="background: #F5F5F5; padding: 5px;" | - | style="background: #F5F5F5; padding: 5px;" |

  • Common in women with a mean age in the mid-40s

| style="background: #F5F5F5; padding: 5px;" |

  • Hooking maneuver

| style="background: #F5F5F5; padding: 5px;" |

  • No specific diagnostic test for this disease
  • The workup is done for excluding cardiac disorders and other causes of chest pain

| style="background: #F5F5F5; padding: 5px;" |

  • EKG is done to rule out other cardiovascular causes

| style="background: #F5F5F5; padding: 5px;" |

  • CXR

| style="background: #F5F5F5; padding: 5px;" |

  • No any gold standard test for this disease

|- style="background: #DCDCDC; padding: 5px; text-align: center;" | |Sternalis syndrome | style="background: #F5F5F5; padding: 5px;" |Chronic | style="background: #F5F5F5; padding: 5px;" |Variable | style="background: #F5F5F5; padding: 5px;" |Pressure like pain

  • Over the body of sternum
  • Sternalis muscle
  • Left or middle side of the chest wall

| style="background: #F5F5F5; padding: 5px;" | - | style="background: #F5F5F5; padding: 5px;" | - | style="background: #F5F5F5; padding: 5px;" | - | style="background: #F5F5F5; padding: 5px;" | - | style="background: #F5F5F5; padding: 5px;" |

| style="background: #F5F5F5; padding: 5px;" |

| style="background: #F5F5F5; padding: 5px;" |

  • No specific diagnostic test for this disease
  • The workup is done for excluding cardiac disorders and other causes of chest pain

| style="background: #F5F5F5; padding: 5px;" |

  • EKG is done to rule out other cardiovascular causes

| style="background: #F5F5F5; padding: 5px;" |

| style="background: #F5F5F5; padding: 5px;" |

  • No any gold standard test for this disease

|- style="background: #DCDCDC; padding: 5px; text-align: center;" | |Tietze's syndrome | style="background: #F5F5F5; padding: 5px;" |Acute | style="background: #F5F5F5; padding: 5px;" |Weeks | style="background: #F5F5F5; padding: 5px;" |Pressure like pain over

| style="background: #F5F5F5; padding: 5px;" | - | style="background: #F5F5F5; padding: 5px;" | - | style="background: #F5F5F5; padding: 5px;" | - | style="background: #F5F5F5; padding: 5px;" | - | style="background: #F5F5F5; padding: 5px;" |

  • Most often involve the areas of 2nd and 3rd ribs
  • More common in young adults

| style="background: #F5F5F5; padding: 5px;" |

| style="background: #F5F5F5; padding: 5px;" |

  • No specific diagnostic test for this disease
  • The workup is done for excluding cardiac disorders and other causes of chest pain

| style="background: #F5F5F5; padding: 5px;" |

  • EKG is done to rule out other cardiovascular causes

| style="background: #F5F5F5; padding: 5px;" |

| style="background: #F5F5F5; padding: 5px;" |

  • Tests are done to rule out other diseases

|- style="background: #DCDCDC; padding: 5px; text-align: center;" | |Xiphoidalgia | style="background: #F5F5F5; padding: 5px;" |Acute | style="background: #F5F5F5; padding: 5px;" |Variable | style="background: #F5F5F5; padding: 5px;" |Pressure like pain over

  • Over the xiphoid process
  • Sternum
  • Xiphisternal joint

| style="background: #F5F5F5; padding: 5px;" | - | style="background: #F5F5F5; padding: 5px;" | - | style="background: #F5F5F5; padding: 5px;" | - | style="background: #F5F5F5; padding: 5px;" | - | style="background: #F5F5F5; padding: 5px;" |

  • Symptoms are aggravated by twisting and bending movements

| style="background: #F5F5F5; padding: 5px;" |

  • Provocative test

| style="background: #F5F5F5; padding: 5px;" |

  • No specific diagnostic test for this disease
  • The workup is done for excluding cardiac disorders and other causes of chest pain

| style="background: #F5F5F5; padding: 5px;" |

  • EKG is done to rule out other cardiovascular causes

| style="background: #F5F5F5; padding: 5px;" |

  • X-ray

| style="background: #F5F5F5; padding: 5px;" |

  • Tests are done to rule out other diseases

|- style="background: #DCDCDC; padding: 5px; text-align: center;" | |Spontaneous sternoclavicular subluxation | style="background: #F5F5F5; padding: 5px;" |Acute, Chronic | style="background: #F5F5F5; padding: 5px;" |Variable | style="background: #F5F5F5; padding: 5px;" |Aching pain over Sternoclavicular joint | style="background: #F5F5F5; padding: 5px;" | - | style="background: #F5F5F5; padding: 5px;" | - | style="background: #F5F5F5; padding: 5px;" | - | style="background: #F5F5F5; padding: 5px;" | - | style="background: #F5F5F5; padding: 5px;" |

  • More common in middle age women
  • Occurs in dominant hands with repetitive tasks of heavy or moderate quality

| style="background: #F5F5F5; padding: 5px;" |

| style="background: #F5F5F5; padding: 5px;" |

  • No specific diagnostic test for this disease
  • The workup is done for excluding cardiac disorders and other causes of chest pain

| style="background: #F5F5F5; padding: 5px;" |

  • EKG is done to rule out other cardiovascular causes

| style="background: #F5F5F5; padding: 5px;" |

| style="background: #F5F5F5; padding: 5px;" |

|- style="background: #4479BA; color: #FFFFFF; text-align: center;" ! rowspan="3" |Differentials on the basis of Etiology ! rowspan="3" |Disease ! colspan="9" |Clinical manifestations ! colspan="4" |Diagnosis |- style="background: #4479BA; color: #FFFFFF; text-align: center;" | colspan="8" |Symptoms ! rowspan="2" |Physical exam ! rowspan="2" |Lab Findings ! rowspan="2" |EKG ! rowspan="2" |Imaging ! rowspan="2" |Gold standard |- style="background: #4479BA; color: #FFFFFF; text-align: center;" !Onset !Duration !Type of Pain !Cough !Fever !Dyspnea !Weight loss !Associated Features |- style="background: #DCDCDC; padding: 5px; text-align: center;" | | rowspan="7" |Rheumatic |Fibromyalgia | style="background: #F5F5F5; padding: 5px;" |Chronic | style="background: #F5F5F5; padding: 5px;" |Variable | style="background: #F5F5F5; padding: 5px;" |

| style="background: #F5F5F5; padding: 5px;" | - | style="background: #F5F5F5; padding: 5px;" | - | style="background: #F5F5F5; padding: 5px;" | + | style="background: #F5F5F5; padding: 5px;" | - | style="background: #F5F5F5; padding: 5px;" |

| style="background: #F5F5F5; padding: 5px;" |

  • Presence of tenderness in soft-tissue anatomic locations

| style="background: #F5F5F5; padding: 5px;" |

| style="background: #F5F5F5; padding: 5px;" |

  • P-wave dispersions (Pd)

| style="background: #F5F5F5; padding: 5px;" |

  • MRI

| style="background: #F5F5F5; padding: 5px;" |

  • No any gold standard test is availble

|- style="background: #DCDCDC; padding: 5px; text-align: center;" | |Rheumatoid arthritis | style="background: #F5F5F5; padding: 5px;" |Chronic | style="background: #F5F5F5; padding: 5px;" |Years | style="background: #F5F5F5; padding: 5px;" |Symmetrical joint pain in

  • Wrist
  • Fingers
  • Knees
  • Feet
  • Ankles

| style="background: #F5F5F5; padding: 5px;" | - | style="background: #F5F5F5; padding: 5px;" | + | style="background: #F5F5F5; padding: 5px;" | - | style="background: #F5F5F5; padding: 5px;" | + | style="background: #F5F5F5; padding: 5px;" |

| style="background: #F5F5F5; padding: 5px;" |

| style="background: #F5F5F5; padding: 5px;" |

  • Positive Rheumatic Factor
  • Anti-CCP body 

| style="background: #F5F5F5; padding: 5px;" |

  • ECG is done rule out the heart failure as RA is one of the causes of heart failure

| style="background: #F5F5F5; padding: 5px;" |

  • Plain film radiography of the affected joints
  • MRI
  • Ultrasonography

| style="background: #F5F5F5; padding: 5px;" |

  • No any gold standard test for diagnosis of Rheumatoid Arthritis

|- style="background: #DCDCDC; padding: 5px; text-align: center;" | |Ankylosing spondylitis | style="background: #F5F5F5; padding: 5px;" |Chronic | style="background: #F5F5F5; padding: 5px;" |Years | style="background: #F5F5F5; padding: 5px;" |Intermittent pain in

| style="background: #F5F5F5; padding: 5px;" | - | style="background: #F5F5F5; padding: 5px;" | - | style="background: #F5F5F5; padding: 5px;" | - | style="background: #F5F5F5; padding: 5px;" | - | style="background: #F5F5F5; padding: 5px;" |

| style="background: #F5F5F5; padding: 5px;" |

| style="background: #F5F5F5; padding: 5px;" |

| style="background: #F5F5F5; padding: 5px;" |

  • ECG is done to rule out conductions defects and aortic insufficiency

| style="background: #F5F5F5; padding: 5px;" |

  • Computed tomography (CT)
  • Magnetic resonance imaging (MRI)
  • Power Doppler ultrasonography

| style="background: #F5F5F5; padding: 5px;" |

  • Plain films of the sacroiliac joints

|- style="background: #DCDCDC; padding: 5px; text-align: center;" | |Psoriatic arthritis | style="background: #F5F5F5; padding: 5px;" |Chronic | style="background: #F5F5F5; padding: 5px;" |Years | style="background: #F5F5F5; padding: 5px;" |Asymmetrical intermittent pain in

| style="background: #F5F5F5; padding: 5px;" | - | style="background: #F5F5F5; padding: 5px;" | - | style="background: #F5F5F5; padding: 5px;" | - | style="background: #F5F5F5; padding: 5px;" | - | style="background: #F5F5F5; padding: 5px;" |

| style="background: #F5F5F5; padding: 5px;" |

| style="background: #F5F5F5; padding: 5px;" |

  • Serum complement
  • Levels of Long Prentaxin 3 protein (PTX3)
  • Increased levels of CRP
  • Erythrocyte sedimentation rate
  • Rheumatoid factor
  • Immunoglobulin

| style="background: #F5F5F5; padding: 5px;" |

  • Longer PR interval 

| style="background: #F5F5F5; padding: 5px;" |

  • X-ray of the involved joints
  • CT scanning
  • MRI
  • Ultrasonography

| style="background: #F5F5F5; padding: 5px;" |

  • No any gold standard test is available for this test

|- style="background: #DCDCDC; padding: 5px; text-align: center;" | |Sternocostoclavicular hyperostosis (SAPHO syndrome) | style="background: #F5F5F5; padding: 5px;" |Chronic | style="background: #F5F5F5; padding: 5px;" |Years | style="background: #F5F5F5; padding: 5px;" |Recurrent and multifocal pain in Sternoclavicular joint | style="background: #F5F5F5; padding: 5px;" | - | style="background: #F5F5F5; padding: 5px;" | + | style="background: #F5F5F5; padding: 5px;" | - | style="background: #F5F5F5; padding: 5px;" | - | style="background: #F5F5F5; padding: 5px;" |

| style="background: #F5F5F5; padding: 5px;" |

  • Depending on the type of joint affected

| style="background: #F5F5F5; padding: 5px;" |

| style="background: #F5F5F5; padding: 5px;" |

  • ECG is done to rule out conductions defects and aortic insufficiency

| style="background: #F5F5F5; padding: 5px;" |

  • Plain radiography
  • Computed tomography
  • Bone scan
  • Magnetic resonance imaging
  • Positron emission tomography

| style="background: #F5F5F5; padding: 5px;" |

  • No any gold standard test is available for this disease

|- style="background: #DCDCDC; padding: 5px; text-align: center;" | |Systemic lupus erythematosus  | style="background: #F5F5F5; padding: 5px;" |Chronic | style="background: #F5F5F5; padding: 5px;" |Years | style="background: #F5F5F5; padding: 5px;" |

  • Skin
  • Joints (fingers, wrist, knees)
  • Kidneys
  • SLE can affect any organ of the body

| style="background: #F5F5F5; padding: 5px;" | - | style="background: #F5F5F5; padding: 5px;" | + | style="background: #F5F5F5; padding: 5px;" | + | style="background: #F5F5F5; padding: 5px;" | + | style="background: #F5F5F5; padding: 5px;" |

  • HLA-genetic mutations
  • Female gender
  • Being younger than 50 

| style="background: #F5F5F5; padding: 5px;" |

| style="background: #F5F5F5; padding: 5px;" |

| style="background: #F5F5F5; padding: 5px;" |

| style="background: #F5F5F5; padding: 5px;" |

  • Joint radiography
  • Chest X-ray
  • CT Scan
  • MRI
  • Echocardiography
  • Arthrocentesis
  • Lumbar puncture

| style="background: #F5F5F5; padding: 5px;" |

  • Anti-dsDNA antibody test

|- style="background: #DCDCDC; padding: 5px; text-align: center;" | |Relapsing polychondritis | style="background: #F5F5F5; padding: 5px;" |Chronic | style="background: #F5F5F5; padding: 5px;" |Years | style="background: #F5F5F5; padding: 5px;" |Intermittent pain in

| style="background: #F5F5F5; padding: 5px;" | + | style="background: #F5F5F5; padding: 5px;" | + | style="background: #F5F5F5; padding: 5px;" | + | style="background: #F5F5F5; padding: 5px;" | + | style="background: #F5F5F5; padding: 5px;" |

| style="background: #F5F5F5; padding: 5px;" |

| style="background: #F5F5F5; padding: 5px;" |

  • Negative rheumatoid factor
  • Biopsy
  • Complete blood cell count (CBC) with differential
  • Metabolic panel
  • Serum creatinine
  • Liver transaminase and serum alkaline phosphatase studies
  • Urinalysis dipstick and microscopic evaluation of sediment
  • Cryoglobulins
  • Viral hepatitis panel
  • Antinuclear antibody (ANA)
  • Antineutrophil cytoplasmic antibody (ANCA)

| style="background: #F5F5F5; padding: 5px;" |

  • ECG is done to rule out the cardiovascular complications of this disease

| style="background: #F5F5F5; padding: 5px;" |

  • Chest radiography
  • Spiral CT scanning
  • FDG-PET/CT
  • MRI
  • Posteroanterior and lateral dye contrast pharyngotracheogram
  • Scintigraphy

| style="background: #F5F5F5; padding: 5px;" |

  • No gold standard test for this disease

|- style="background: #DCDCDC; padding: 5px; text-align: center;" | |Psychiatric |Panic attack/ Disorder | style="background: #F5F5F5; padding: 5px;" |Acute or subacute or chronic | style="background: #F5F5F5; padding: 5px;" |Variable | style="background: #F5F5F5; padding: 5px;" |Variable | style="background: #F5F5F5; padding: 5px;" | + | style="background: #F5F5F5; padding: 5px;" | - | style="background: #F5F5F5; padding: 5px;" | + | style="background: #F5F5F5; padding: 5px;" | - | style="background: #F5F5F5; padding: 5px;" |

| style="background: #F5F5F5; padding: 5px;" |

| style="background: #F5F5F5; padding: 5px;" |

  • Thyroid function tests
  • Complete blood count
  • Chemistry panel

| style="background: #F5F5F5; padding: 5px;" |

  • Sinus Tachycardia

| style="background: #F5F5F5; padding: 5px;" |

  • No any specific radiographic test is done

| style="background: #F5F5F5; padding: 5px;" |

  • No gold standard test for panic attack

|- style="background: #DCDCDC; padding: 5px; text-align: center;" | | rowspan="2" |Others |Substance abuse (Cocaine) | style="background: #F5F5F5; padding: 5px;" |Acute (hours) | style="background: #F5F5F5; padding: 5px;" |Pressure like pain in the center of chest | style="background: #F5F5F5; padding: 5px;" | | style="background: #F5F5F5; padding: 5px;" | + | style="background: #F5F5F5; padding: 5px;" | + | style="background: #F5F5F5; padding: 5px;" | + | style="background: #F5F5F5; padding: 5px;" | + | style="background: #F5F5F5; padding: 5px;" |

| style="background: #F5F5F5; padding: 5px;" |

| style="background: #F5F5F5; padding: 5px;" |

| style="background: #F5F5F5; padding: 5px;" |

    • QT prolongation
    • Sinus Tachycardia
    • Arrhythmias
    • Cardiac conduction abnormalities

| style="background: #F5F5F5; padding: 5px;" |

  • Brain CT scan

| style="background: #F5F5F5; padding: 5px;" |

  • Gold standard test depends on the type of substance is abuse

|- style="background: #DCDCDC; padding: 5px; text-align: center;" | |Herpes Zoster | style="background: #F5F5F5; padding: 5px;" |Acute or Chronic | style="background: #F5F5F5; padding: 5px;" |Variable | style="background: #F5F5F5; padding: 5px;" |Burning pain on

  • Chest
  • Upper back
  • Lower back

| style="background: #F5F5F5; padding: 5px;" | - | style="background: #F5F5F5; padding: 5px;" | + | style="background: #F5F5F5; padding: 5px;" | - | style="background: #F5F5F5; padding: 5px;" | - | style="background: #F5F5F5; padding: 5px;" |

| style="background: #F5F5F5; padding: 5px;" |

| style="background: #F5F5F5; padding: 5px;" |

| style="background: #F5F5F5; padding: 5px;" |

  • ECG is done to rule out other cardiovascular causes of chest pain

| style="background: #F5F5F5; padding: 5px;" |

  • Magnetic resonance imaging (MRI)

| style="background: #F5F5F5; padding: 5px;" |

  • Viral tissue culture

|}

References

  1. ↑ Geibel A, Zehender M, Kasper W, Olschewski M, Klima C, Konstantinides SV (2005). "Prognostic value of the ECG on admission in patients with acute major pulmonary embolism". Eur Respir J. 25 (5): 843–8. doi:10.1183/09031936.05.00119704. PMID 15863641.
  2. ↑ Ferrari E, Imbert A, Chevalier T, Mihoubi A, Morand P, Baudouy M (1997). "The ECG in pulmonary embolism. Predictive value of negative T waves in precordial leads--80 case reports". Chest. 111 (3): 537–43. PMID 9118684.
  3. ↑ Rodger M, Makropoulos D, Turek M, Quevillon J, Raymond F, Rasuli P; et al. (2000). "Diagnostic value of the electrocardiogram in suspected pulmonary embolism". Am J Cardiol. 86 (7): 807–9, A10. PMID 11018210.
  4. ↑ Shopp JD, Stewart LK, Emmett TW, Kline JA (2015). "Findings From 12-lead Electrocardiography That Predict Circulatory Shock From Pulmonary Embolism: Systematic Review and Meta-analysis". Acad Emerg Med. 22 (10): 1127–37. doi:10.1111/acem.12769. PMC 5306533. PMID 26394330.
  5. ↑ Stein PD, Saltzman HA, Weg JG (1991). "Clinical characteristics of patients with acute pulmonary embolism". Am J Cardiol. 68 (17): 1723–4. PMID 1746481.
  6. ↑ Panos RJ, Barish RA, Whye DW, Groleau G (1988). "The electrocardiographic manifestations of pulmonary embolism". J Emerg Med. 6 (4): 301–7. PMID 3225435.
  7. ↑ Thames MD, Alpert JS, Dalen JE (1977). "Syncope in patients with pulmonary embolism". JAMA. 238 (23): 2509–11. PMID 578884.
  8. ↑ Walston A, Brewer DL, Kitchens CS, Krook JE (1974). "The electrocardiographic manifestations of spontaneous left pneumothorax". Ann Intern Med. 80 (3): 375–9. PMID 4816180.
  9. ↑ Fruergaard P, Launbjerg J, Hesse B, Jørgensen F, Petri A, Eiken P, Aggestrup S, Elsborg L, Mellemgaard K (1996). "The diagnoses of patients admitted with acute chest pain but without myocardial infarction". European Heart Journal. 17 (7): 1028–34. PMID 8809520. Retrieved 2012-05-02. Unknown parameter |month= ignored (help)
  10. ↑ 10.0 10.1 Svavarsdóttir AE, Jónasson MR, Gudmundsson GH, Fjeldsted K (June 1996). "Chest pain in family practice. Diagnosis and long-term outcome in a community setting". Can Fam Physician. 42: 1122–8. PMC 2146490. PMID 8704488.
  11. ↑ 11.0 11.1 Klinkman MS, Stevens D, Gorenflo DW (April 1994). "Episodes of care for chest pain: a preliminary report from MIRNET. Michigan Research Network". J Fam Pract. 38 (4): 345–52. PMID 8163958.
  12. ↑ 12.0 12.1 Bösner S, Becker A, Haasenritter J, Abu Hani M, Keller H, Sönnichsen AC, Karatolios K, Schaefer JR, Seitz G, Baum E, Donner-Banzhoff N (2009). "Chest pain in primary care: epidemiology and pre-work-up probabilities". Eur J Gen Pract. 15 (3): 141–6. doi:10.3109/13814780903329528. PMID 19883149.
  13. ↑ 13.0 13.1 Ebell MH (March 2011). "Evaluation of chest pain in primary care patients". Am Fam Physician. 83 (5): 603–5. PMID 21391528.
  14. ↑ von Kodolitsch Y, Schwartz AG, Nienaber CA (October 2000). "Clinical prediction of acute aortic dissection". Arch. Intern. Med. 160 (19): 2977–82. PMID 11041906.
  15. ↑ 15.0 15.1 Pate JW, Walker WA, Cole FH, Owen EW, Johnson WH (May 1989). "Spontaneous rupture of the esophagus: a 30-year experience". Ann. Thorac. Surg. 47 (5): 689–92. PMID 2730190.
  16. ↑ Fleet RP, Dupuis G, Marchand A, Burelle D, Beitman BD (October 1994). "Panic disorder, chest pain and coronary artery disease: literature review". Can J Cardiol. 10 (8): 827–34. PMID 7954018.
  17. ↑ Bass C, Chambers JB, Kiff P, Cooper D, Gardner WN (December 1988). "Panic anxiety and hyperventilation in patients with chest pain: a controlled study". Q. J. Med. 69 (260): 949–59. PMID 3270082.
  18. ↑ Evans DW, Lum LC (January 1977). "Hyperventilation: An important cause of pseudoangina". Lancet. 1 (8004): 155–7. PMID 64694.
  19. ↑ Ros E, Armengol X, Grande L, Toledo-Pimentel V, Lacima G, Sanz G (July 1997). "Chest pain at rest in patients with coronary artery disease. Myocardial ischemia, esophageal dysfunction, or panic disorder?". Dig. Dis. Sci. 42 (7): 1344–53. PMID 9246027.
  20. ↑ Ben Freedman S, Tennant CC (April 1998). "Panic disorder and coronary artery spasm". Med. J. Aust. 168 (8): 376–7. PMID 9594945.
  21. ↑ Smoller JW, Pollack MH, Wassertheil-Smoller S, Jackson RD, Oberman A, Wong ND, Sheps D (October 2007). "Panic attacks and risk of incident cardiovascular events among postmenopausal women in the Women's Health Initiative Observational Study". Arch. Gen. Psychiatry. 64 (10): 1153–60. doi:10.1001/archpsyc.64.10.1153. PMID 17909127.
  22. ↑ Mehta NJ, Khan IA (November 2002). "Cardiac Munchausen syndrome". Chest. 122 (5): 1649–53. PMID 12426266.
  23. ↑ Swap CJ, Nagurney JT (November 2005). "Value and limitations of chest pain history in the evaluation of patients with suspected acute coronary syndromes". JAMA. 294 (20): 2623–9. doi:10.1001/jama.294.20.2623. PMID 16304077.
  24. ↑ Marcus GM, Cohen J, Varosy PD, Vessey J, Rose E, Massie BM, Chatterjee K, Waters D (January 2007). "The utility of gestures in patients with chest discomfort". Am. J. Med. 120 (1): 83–9. doi:10.1016/j.amjmed.2006.05.045. PMID 17208083.
  25. ↑ Verdon F, Burnand B, Herzig L, Junod M, Pécoud A, Favrat B (September 2007). "Chest wall syndrome among primary care patients: a cohort study". BMC Fam Pract. 8: 51. doi:10.1186/1471-2296-8-51. PMC 2072948. PMID 17850647.
  26. ↑ Davies HA, Jones DB, Rhodes J, Newcombe RG (December 1985). "Angina-like esophageal pain: differentiation from cardiac pain by history". J. Clin. Gastroenterol. 7 (6): 477–81. PMID 4086742.
  27. ↑ Panju AA, Hemmelgarn BR, Guyatt GH, Simel DL (October 1998). "The rational clinical examination. Is this patient having a myocardial infarction?". JAMA. 280 (14): 1256–63. PMID 9786377.
  28. ↑ Berger JP, Buclin T, Haller E, Van Melle G, Yersin B (March 1990). "Right arm involvement and pain extension can help to differentiate coronary diseases from chest pain of other origin: a prospective emergency ward study of 278 consecutive patients admitted for chest pain". J. Intern. Med. 227 (3): 165–72. PMID 2313224.
  29. ↑ Yelland MJ (September 2001). "Back, chest and abdominal pain. How good are spinal signs at identifying musculoskeletal causes of back, chest or abdominal pain?". Aust Fam Physician. 30 (9): 908–12. PMID 11676323.
  30. ↑ Chan S, Maurice AP, Davies SR, Walters DL (October 2014). "The use of gastrointestinal cocktail for differentiating gastro-oesophageal reflux disease and acute coronary syndrome in the emergency setting: a systematic review". Heart Lung Circ. 23 (10): 913–23. doi:10.1016/j.hlc.2014.03.030. PMID 24791662.
  31. ↑ Henrikson CA, Howell EE, Bush DE, Miles JS, Meininger GR, Friedlander T, Bushnell AC, Chandra-Strobos N (December 2003). "Chest pain relief by nitroglycerin does not predict active coronary artery disease". Ann. Intern. Med. 139 (12): 979–86. PMID 14678917.
  32. ↑ Pryor DB, Harrell FE, Lee KL, Califf RM, Rosati RA (November 1983). "Estimating the likelihood of significant coronary artery disease". Am. J. Med. 75 (5): 771–80. PMID 6638047.
  33. ↑ Buntinx F, Knockaert D, Bruyninckx R, de Blaey N, Aerts M, Knottnerus JA, Delooz H (December 2001). "Chest pain in general practice or in the hospital emergency department: is it the same?". Fam Pract. 18 (6): 586–9. PMID 11739341.
  34. ↑ Tierney WM, Roth BJ, Psaty B, McHenry R, Fitzgerald J, Stump DL, Anderson FK, Ryder KW, McDonald CJ, Smith DM (July 1985). "Predictors of myocardial infarction in emergency room patients". Crit. Care Med. 13 (7): 526–31. PMID 4006491.
  35. ↑ Sequist TD, Marshall R, Lampert S, Buechler EJ, Lee TH (November 2006). "Missed opportunities in the primary care management of early acute ischemic heart disease". Arch. Intern. Med. 166 (20): 2237–43. doi:10.1001/archinte.166.20.2237. PMID 17101942.
  36. ↑ Norell M, Lythall D, Coghlan G, Cheng A, Kushwaha S, Swan J, Ilsley C, Mitchell A (January 1992). "Limited value of the resting electrocardiogram in assessing patients with recent onset chest pain: lessons from a chest pain clinic". Br Heart J. 67 (1): 53–6. PMC 1024701. PMID 1739527.
  37. ↑ Law K, Elley R, Tietjens J, Mann S (July 2006). "Troponin testing for chest pain in primary healthcare: a survey of its use by general practitioners in New Zealand". N. Z. Med. J. 119 (1238): U2082. PMID 16868579.
  38. ↑ Wilhelmsen L, Rosengren A, Hagman M, Lappas G (July 1998). ""Nonspecific" chest pain associated with high long-term mortality: results from the primary prevention study in Göteborg, Sweden". Clin Cardiol. 21 (7): 477–82. PMID 9669056.
  39. ↑ Ruigómez A, Rodríguez LA, Wallander MA, Johansson S, Jones R (April 2006). "Chest pain in general practice: incidence, comorbidity and mortality". Fam Pract. 23 (2): 167–74. doi:10.1093/fampra/cmi124. PMID 16461444.
  40. ↑ Robinson JG, Wallace R, Limacher M, Sato A, Cochrane B, Wassertheil-Smoller S, Ockene JK, Blanchette PL, Ko MG (December 2006). "Elderly women diagnosed with nonspecific chest pain may be at increased cardiovascular risk". J Womens Health (Larchmt). 15 (10): 1151–60. doi:10.1089/jwh.2006.15.1151. PMID 17199456.
  41. ↑ Geraldine McMahon C, Yates DW, Hollis S (February 2008). "Unexpected mortality in patients discharged from the emergency department following an episode of nontraumatic chest pain". Eur J Emerg Med. 15 (1): 3–8. doi:10.1097/MEJ.0b013e32827b14cd. PMID 18180659.
  42. ↑ Yelland M, Cayley WE, Vach W (March 2010). "An algorithm for the diagnosis and management of chest pain in primary care". Med. Clin. North Am. 94 (2): 349–74. doi:10.1016/j.mcna.2010.01.011. PMID 20380960.
  43. ↑ Wang WH, Huang JQ, Zheng GF, Wong WM, Lam SK, Karlberg J, Xia HH, Fass R, Wong BC (June 2005). "Is proton pump inhibitor testing an effective approach to diagnose gastroesophageal reflux disease in patients with noncardiac chest pain?: a meta-analysis". Arch. Intern. Med. 165 (11): 1222–8. doi:10.1001/archinte.165.11.1222. PMID 15956000.
  44. ↑ Borzecki AM, Pedrosa MC, Prashker MJ (March 2000). "Should noncardiac chest pain be treated empirically? A cost-effectiveness analysis". Arch. Intern. Med. 160 (6): 844–52. PMID 10737285.
  45. ↑ Wertli MM, Ruchti KB, Steurer J, Held U (November 2013). "Diagnostic indicators of non-cardiovascular chest pain: a systematic review and meta-analysis". BMC Med. 11: 239. doi:10.1186/1741-7015-11-239. PMC 4226211. PMID 24207111.
Retrieved from "https://www.wikidoc.org/index.php?title=Chest_pain_differential_diagnosis&oldid=1447571"