DDx of Chest Pain

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!


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


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

Chest Wall

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


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


    • Anxiety
    • Depression
    • Somatization Disorder
    • Panic attack


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


  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

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