Which of the following lists constitutes the differential diagnoses to consider for chest pain?

• A. Pulmonary Embolism, Aortic Dissection, Arrhythmia
• B. Abdominal pathology, Pneumothorax, Pericarditis
• C. Pulmonary Embolism, Aortic Dissection, Arrhythmia, Abdominal pathology, Pneumothorax
• D. Pulmonary Embolism, Aortic Dissection, Arrhythmia, Abdominal pathology, Pneumothorax, Pericarditis

Answer: (D)

When evaluating chest pain, you need a broad differential that spans heart, lungs, vessels, and other possible sources that can mimic cardiac discomfort. The most complete list includes pulmonary embolism, aortic dissection, arrhythmia, abdominal pathology, pneumothorax, and pericarditis. Each category covers a key set of causes: pulmonary embolism can present with sudden chest pain and shortness of breath and is a medical emergency; aortic dissection typically causes abrupt, severe chest pain often described as tearing and may radiate to the back; arrhythmias can provoke chest pain when rapid or irregular heart activity leads to myocardial ischemia; abdominal pathology can present as chest or epigastric pain or referred pain to the chest (think pancreatitis, biliary disease, severe GERD); pneumothorax presents with sudden pleuritic chest pain and breathlessness; pericarditis causes sharp, pleuritic chest pain that often improves when leaning forward and may be accompanied by a friction rub. Omitting any of these categories risks missing a serious or alternative cause of chest pain, so a list that includes all six is the most appropriate differential.