Differential Diagnosis of Chest Pain Excluding Epicardial Atherosclerosis
| Diagnosis | Comments |
|---|
| Cardiovascular | | Aortic stenosis | Anginal episodes can occur with severe aortic stenosis. | | HCM | Subendocardial ischemia may occur with exercise and/or exertion. | | Prinzmetal angina | Coronary vasospasm that may be elicited by exertion or emotional stress. | | Pericarditis | Pleuritic chest pain associated with pericardial inflammation from infectious or autoimmune disease. | | Aortic dissection | May mimic anginal pain and/or involve the coronary arteries. | | Cocaine use | Results in coronary vasospasm and/or thrombus formation. | | Other | | Anemia | Marked anemia can result in a myocardial O2 supply–demand mismatch. | | Thyrotoxicosis | Increase in myocardial demand may result in an O2 supply–demand mismatch. | | Esophageal disease | GERD and esophageal spasm can mimic angina (responsive to NTG). | | Biliary colic | Gallstones can usually be visualized on abdominal sonography. | | Respiratory diseases | Pneumonia with pleuritic pain, pulmonary embolism, pulmonary hypertension. | | Musculoskeletal | Costochondritis, cervical radiculopathy. |
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GERD, gastroesophageal reflux disease; HCM, hypertrophic cardiomyopathy; NTG, nitroglycerin.