This Daily Doodle represents the differential diagnosis of “chest” pain/discomfort which is quite an extensive list of both cardiac and non-cardiac conditions. In the ER, the initial approach to chest pain is to rule out potentially life-threatening causes, the big 5 include: myocardial infarction, pulmonary embolism, aortic dissection, esophageal rupture and tension pneumothorax.

I find that the easiest way to organize the long differential diagnosis list is by dividing them based on systems. Note: the list below is not a complete list!

Cardiovascular

• Ischemic: MI, angina (stable/unstable)
• Non-Ischemic: pericarditis, cardiac tamponade, aortic dissection

Respiratory

• Pulmonary Embolism
• Pneumonia
• Hemothorax
• Pneumothorax, Tension pneumothorax
• Tuberculosis
• Pleuritis
• Lung malignancy

Chest Wall

• Costochondritis
• Herpes Zoster (Shingles)
• Fractured rib
• Rheumatoid arthritis
• Muscular pathology

Gastrointestinal

• Gastroesophageal reflux disease
• Esophagitis
• Gastritis
• Esophageal spasm
• Peptic ulcer Disease
• Mallory Weiss Tear
• Pancreatitis
• Biliary Disease

Psychological

• Anxiety
• Depression
• Somatization Disorder
• Panic attack

Here is a doodle of my doodle which helps explain what all the characters are inside the chest.

References:

1. James L Meisel, MD, FACP and Daniel Cottrell, MD “Differential diagnosis of chest pain in adults ” Uptodate. 2014 – http://www.uptodate.com/contents/differential-diagnosis-of-chest-pain-in-adults

“Chest Pain” Daily Doodle by Michiko Maruyama