Chest Pain

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Ahhh, chest pain. My favorite, your favorite. Chest pain can range from benign to completely lethal, which is why health care professionals often develop sympathy chest pain when evaluating the patient with chest pain.[1] The differential diagnosis for chest pain is a long one. Buckle up and here we go!


It is best to divide the causes of chest pain into systems: cardiac, pulmonary, gastrointestinal, musculoskeletal, hematologic, psychiatric, and other bullsh*t.

Cardiac - The old ticker is potentially a ticking time bomb, and that's we have to take it seriously. The list of cardiac causes runs long:

  • Myocardial ischemia - This results from supply-demand mismatch or someone scaring the sh*t out of you.[2]
  • Aortic dissection - If you can avoid dissecting your aorta, we highly recommend it.
  • Pericardiitis - We recommend against heart inflammation.
  • Heart failure - Not just CHF exacerbation, but CHF exasperation as well.
  • Arrhythmia - This can include A-fib, B-fib, C-fib, V-tach, W, tach, and X-tach.

Pulmonary - This list is pretty damn long too. The lungs hate playing second fiddle to the heart, so it has nice list of its own:

  • Pneumonia - See Pneumonia.
  • Pneumothorax - Blame the intern who did it.[3]
  • Pulmonary embolism - See Pulmonary Embolism.
  • Reacting airway disease - Includes asthma and COPD. Tell those lungs to stop overreacting.

Gastrointestinal - That sneaky esophagus and stomach sit right behind the heart.

  • GERD, gastritis, or peptic ulcer disease (PUD) - All from the dreaded PPI deficiency.
  • Esophagitis - May be infectious (Candida), noninfectious (eosinophilic), or something else (swallowed a sword)[4]
  • Esophageal spasm - A Charlie horse of the swallowing tube.
  • Boerhaave syndrome - It's better to Boerhaaven't than Boerhaave.

Musculoskeletal - A history and reproducible tenderness to palpation on exam here is overrated.

  • Costochondritis - The most common.
  • Costcochondritis - The most common form of musculoskeletal pain in a Costco.
  • Trauma - Includes falling on your chest, donkey kicking you in the chest, ninja kicking you in the chest, actually elephant standing on your chest.

Psychiatric - This list isn't too long.

  • Panic attack - See? Just panic attack. Not a long list at all.[5]

Other bullsh*t - Way more common than we'd like.

  • Chest pain as a result of waiting too long in the ER[6]
  • Chest pain as a complaint to somehow score narcotics
  • Recent titty twist[7]
  • Thoracic gout - Gotta think outside the box right?
  • Syphilis - You just never know.
  • Still's disease - A differential diagnosis is never complete without it.


  1. Intern Has Mild Troponin Bump Over Patient’s Mild Troponin Bump (Gomerblog)
  2. New Surgical Jason Masks Loved by Nurses, Doctors (Gomerblog)
  3. July Intern Really Excited to Cause His Very First Pneumothorax (Gomerblog)
  4. Sword Swallower Wondering Why He Has Reflux All of a Sudden (Gomerblog)
  5. Breaking: Xanax Prescriptions Skyrocket for Election Day (Gomerblog)
  6. Tired of Waiting, Patient Develops “Chest Pain” in ER (Gomerblog)
  7. Study: Titty Twist Better Pain Stimulus Than Sternal Rub (Gomerblog)

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