Differential diagnosis for retrosternal chest pain

Differential diagnosis

Differential diagnosis for retrosternal chest pain

Common and important causes of retrosternal chest pain for doctors and medical students

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Diagnosis	Evidence
Gastroesophageal reflux/gastritis	Suggested by: central or epigastric burning pain, onset over hours, dyspepsia, worse lying flat, worsened by food, alcohol, NSAIDs. Confirmed by: OGD showing inflamed mucosa.
Biliary colic	Suggested by: postprandial pain, severe and “gripping” or colicky, usually in right upper quadrant (RUQ) and that can radiate to right scapula. Onset over hours. Confirmed by: ultrasound showing gallstones and biliary dilatation or characteristic findings on ERCP.
Pancreatitis (often due to gallstone impacted in common bile duct)	Suggested by: mid-epigastric pain radiating to back, associated with nausea and vomiting, gallstones. Onset over hours. Confirmed by: increased serum amylase to 5 times normal, increased serum lipase.
Myocardial infarction (often inferior)	Suggested by: continuous pain, usually over 30 minutes, not relieved by rest or antianginal medication. Onset over minutes to hours. Confirmed by: T wave inversion ± ST elevation of 1 mm in limb leads or 2 mm in chest leads on serial ECGs or increased troponin.

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