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I now have comprehensive definitions from authoritative textbooks for all diseases in your document. Here is the complete compilation:

Exact Definitions of All Diseases in the Differential Diagnosis of Chest Pain

I. CARDIAC CAUSES

1. Angina Pectoris

Patients with angina pectoris from underlying coronary artery disease (CAD) frequently describe the discomfort as anterior chest tightness or pain. Other descriptions include anterior chest burning, pressing, choking, aching, gas, and indigestion. These symptoms are typically located in the retrosternal area or the left chest, with usual radiation to the left shoulder, left arm, or jaw. Typical angina is aggravated by exercise and relieved by rest.
Unstable angina has three main presentations: angina at rest, new-onset angina, and increasing angina. — Swanson's Family Medicine Review

2. Acute Myocardial Infarction (AMI)

Defined by the Fourth Universal Definition of Myocardial Infarction, AMI is classified into five types:
  • Type 1 — Spontaneous MI (atherosclerotic plaque rupture/erosion causing coronary thrombosis)
  • Type 2 — MI due to ischemic imbalance (supply/demand mismatch without primary coronary thrombosis)
  • Type 3 — MI resulting in sudden cardiac death before biomarkers can be obtained
  • Type 4 — Percutaneous coronary intervention (PCI)-related MI
  • Type 5 — Coronary artery bypass graft (CABG)-associated MI
— Sabiston Textbook of Surgery; Goldman-Cecil Medicine

3. Variant (Prinzmetal) Angina

In variant angina, coronary constriction (vasospasm) results in reduced blood flow and ischemic pain. Multiple mechanisms have been proposed to initiate vasospasm, including endothelial cell injury. While long-acting nitrates alone are occasionally efficacious in abolishing episodes, additional therapy with Ca²⁺ channel blockers is usually required. — Goodman & Gilman's The Pharmacological Basis of Therapeutics

4. Pericarditis

Acute Pericarditis is defined as an inflammatory pericardial syndrome, diagnosed when at least 2 of the 4 following criteria are present:
  1. Pericarditis chest pain (classically sharp, pleuritic, and positional — worsens supine, relieves leaning forward)
  2. Pericardial friction rub
  3. Characteristic ECG change (new widespread ST-segment elevation or PR-segment depression)
  4. Pericardial effusion (new or worsening)
Additional supporting findings: elevated CRP/ESR/WBC; evidence of pericardial inflammation on CT or cardiac MRI. — Fuster and Hurst's The Heart, 15th Edition

5. Aortic Dissection

Aortic dissection is defined by the presence of an intimal tear that facilitates entry of the fully pressurized circulation into the media, thereby dividing it into two layers — a true lumen and a false lumen. It represents approximately 75% of all acute aortic syndromes.
  • Type A dissection: involves the ascending aorta (most common site of intimal tear is just beyond the aortic valve)
  • Type B dissection: limited to the descending aorta (tear just beyond the ligamentum arteriosum)
The pulsatile blood flow propagates this separation both distally and proximally. Complications include rupture and end-organ malperfusion. — Goldman-Cecil Medicine

6. Aortic Stenosis

Valvar aortic stenosis is one of the most common valvular lesions, usually secondary to a thickened, bicommissural (bicuspid) aortic valve. It is defined by obstruction to left ventricular outflow at the level of the aortic valve, leading to a pressure gradient across the valve. Clinical triad: exertional chest pain (angina), syncope, and heart failure. — Creasy & Resnik's Maternal-Fetal Medicine; Fuster and Hurst's The Heart

7. Hypertrophic Cardiomyopathy (HCM)

Hypertrophic cardiomyopathy is defined as unexplained left ventricular hypertrophy in the absence of abnormal loading conditions (valve disease, hypertension, congenital heart defects) sufficient to explain the degree of hypertrophy. It occurs worldwide in all racial groups, with a prevalence of 0.2–0.5%. It is usually familial with autosomal dominant inheritance; mutations in sarcomeric contractile protein genes account for approximately 50–60% of cases. — Goldman-Cecil Medicine

8. Mitral Valve Prolapse (MVP)

MVP is defined as the systolic displacement of one or both mitral leaflets into the left atrium beyond the mitral annular plane, often producing a mid-systolic click on auscultation. It is associated with atypical chest pain, palpitations, anxiety, and panic. It is the most common cardiac valvular abnormality.

9. Myocarditis

Myocarditis is defined as inflammation of the myocardium (heart muscle), typically presenting with chest pain (pleuritic or dull), elevated troponin, and ECG changes in young patients, usually following a viral prodrome.

II. GASTROINTESTINAL CAUSES

10. Gastroesophageal Reflux Disease (GERD)

GERD develops when the reflux of stomach contents into the esophagus causes troublesome symptoms or complications. It is estimated that GERD (defined as at least weekly heartburn or acid regurgitation) has a prevalence of 10–20% in the Western world. Risk factors include obesity (particularly central obesity) and a positive family history. — Goldman-Cecil Medicine

11. Esophageal Spasm / Motility Disorders

Esophageal spasm (diffuse esophageal spasm, jackhammer esophagus) refers to uncoordinated or hyper-contractile contractions of the esophageal smooth muscle, producing substernal chest pain — often severe — that may occur spontaneously or with swallowing, and is associated with dysphagia. It can closely mimic acute myocardial infarction.

12. Peptic Ulcer Disease (PUD)

Peptic ulcer disease is defined as a break in the gastric or duodenal mucosa that extends through the muscularis mucosae, caused by an imbalance between mucosal protective factors (mucus, bicarbonate, prostaglandins) and injurious factors (acid, pepsin, H. pylori, NSAIDs). It presents as epigastric/lower chest burning related to meals; a perforated ulcer presents acutely.

13. Biliary Colic / Cholecystitis

Biliary colic is defined as episodic right upper quadrant or epigastric pain caused by transient obstruction of the cystic duct by gallstones. Acute cholecystitis is defined as inflammation of the gallbladder, most commonly due to persistent obstruction of the cystic duct by a gallstone. Pain is postprandial (especially after fatty meals), with nausea and vomiting, and may radiate to the right shoulder or scapula.

14. Pancreatitis

Acute pancreatitis is defined as acute inflammation of the pancreas, presenting with severe epigastric pain radiating to the back and chest, associated with nausea/vomiting and elevated amylase/lipase. It is most commonly caused by gallstones or alcohol.

15. Esophageal Perforation (Boerhaave Syndrome)

Boerhaave syndrome is defined as spontaneous, full-thickness rupture of the esophagus, most commonly from a sudden increase in intraesophageal pressure (forceful vomiting). It is a life-threatening emergency presenting with sudden severe chest pain, subcutaneous emphysema, mediastinitis, and Hamman's crunch on auscultation. It requires urgent CT or contrast esophagram.

III. MUSCULOSKELETAL CAUSES

16. Costochondritis (Tietze Syndrome)

Costochondritis is defined as inflammation of the costochondral junctions (most commonly the 2nd–4th ribs), presenting with dull, gnawing, aching chest pain. The diagnostic hallmark is reproducible tenderness on palpation of the affected cartilage. Tietze syndrome specifically includes redness, swelling, and visible enlargement of the costal cartilages.

17. Chest Wall Muscle Strain / Rib Fracture

A rib fracture is a break in the continuity of one or more ribs, typically following trauma, vigorous exercise, or repeated coughing. Presents with localized tenderness, pain worsened by palpation, movement, and deep breathing. Confirmed by X-ray or CT.

18. Intercostal Neuritis / Radiculitis (Herpes Zoster)

Intercostal neuritis refers to inflammation or irritation of intercostal nerves, producing superficial, lancinating, dermatomal chest pain. Herpes Zoster (shingles) is reactivation of the varicella-zoster virus in a dorsal root ganglion, causing unilateral dermatomal burning pain that precedes the vesicular rash by 2–3 days — a notorious diagnostic trap in chest pain presentations.

19. Cervical/Thoracic Spine Disorders (Cervical Radiculopathy)

Cervical radiculopathy is defined as compression or irritation of a cervical nerve root (C4–T1 levels), referring pain to the chest and/or arm. Pain is provoked by neck movement and may be associated with neurological deficits (numbness, weakness).

20. Ankylosing Spondylitis

Ankylosing spondylitis is defined as a chronic inflammatory seronegative spondyloarthropathy primarily affecting the axial skeleton (sacroiliac joints and spine). It presents in young males with progressive chest wall stiffness, back pain, and sacroiliitis, reducing chest expansion and causing chest pain.

21. Thoracic Outlet Syndrome

Thoracic outlet syndrome is defined as compression of the neurovascular structures (brachial plexus, subclavian artery or vein) passing through the thoracic outlet between the clavicle and first rib, producing chest, shoulder, and arm pain that radiates to the arm.

IV. PSYCHOGENIC / PSYCHIATRIC CAUSES

22. Panic Disorder / Panic Attack

Panic attacks, by definition, have a sudden onset and relatively short duration. The first panic attack is often completely spontaneous. The attack typically begins with 10 minutes of rapidly increasing symptoms including extreme fear and a sense of impending death, accompanied by tachycardia, palpitations, dyspnea, sweating, chest tightness, paresthesias, and dizziness. It generally lasts 20–30 minutes and rarely exceeds one hour.
Panic disorder is a chronic condition characterized by recurrent, unexpected panic attacks with persistent concern about future attacks. About 30–40% of patients become symptom-free at long-term follow-up. — Kaplan and Sadock's Synopsis of Psychiatry

23. Generalized Anxiety Disorder (GAD)

GAD is defined as excessive, difficult-to-control worry about multiple domains (health, finances, work) occurring more days than not for at least 6 months, accompanied by physical symptoms including chest tightness, muscle tension, fatigue, and sleep disturbance. In chest pain, hyperventilation leads to hypocapnia, which can trigger coronary vasospasm.

24. Depression / Somatization Disorder

Somatization refers to the expression of psychological distress through physical symptoms without an identifiable organic cause. In the context of chest pain, it presents as atypical chest pain with multiple somatic complaints, chronic in nature, not related to exertion, and accompanied by depressed mood, sleep disturbance, and fatigue.

25. Functional Chest Pain of Esophageal Origin (Functional Heartburn)

Defined under the Rome IV criteria as recurrent substernal chest pain or discomfort in the absence of gastroesophageal reflux disease, eosinophilic esophagitis, or a major esophageal motor disorder. Central sensitization and visceral hypersensitivity are the implicated mechanisms. It is a diagnosis of exclusion after thorough workup.
Sources: Goldman-Cecil Medicine; Fuster and Hurst's The Heart, 15th Ed.; Sabiston Textbook of Surgery; Swanson's Family Medicine Review; Goodman & Gilman's Pharmacological Basis of Therapeutics; Kaplan and Sadock's Synopsis of Psychiatry; Creasy & Resnik's Maternal-Fetal Medicine

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Differential Diagnosis of Chest Pain + Exact Definitions

Chest pain is one of the most challenging diagnostic presentations in medicine because visceral pain from thoracic and upper abdominal organs can be similar and share overlapping referral patterns. Initial approach prioritizes exclusion of life-threatening causes, then targeted evaluation using history, exam, ECG, biomarkers, imaging, and focused testing.

I. Cardiac Causes

1) Angina Pectoris

Patients with angina pectoris from CAD frequently describe anterior chest tightness or pain (burning, pressing, choking, aching, indigestion-like), usually retrosternal or left chest, often radiating to left shoulder/arm/jaw. Typical angina is worsened by exertion and relieved by rest. Unstable angina commonly presents as angina at rest, new-onset angina, or increasing angina. Source: Swanson's Family Medicine Review.

2) Acute Myocardial Infarction (AMI)

Per the Fourth Universal Definition of MI:
  • Type 1: spontaneous MI due to atherosclerotic plaque rupture/erosion with thrombosis
  • Type 2: MI due to oxygen supply-demand mismatch without primary coronary thrombosis
  • Type 3: sudden cardiac death suggestive of MI before biomarker confirmation
  • Type 4: PCI-related MI
  • Type 5: CABG-related MI Sources: Sabiston Textbook of Surgery; Goldman-Cecil Medicine.

3) Variant (Prinzmetal) Angina

Defined by transient coronary vasospasm causing reduced coronary blood flow and ischemic chest pain, often at rest; nitrates and calcium channel blockers are key therapies. Source: Goodman and Gilman's Pharmacological Basis of Therapeutics.

4) Acute Pericarditis

Inflammatory pericardial syndrome diagnosed by at least 2 of 4:
  1. Typical pericarditic chest pain (sharp, pleuritic, positional)
  2. Pericardial friction rub
  3. Typical ECG changes (diffuse ST elevation or PR depression)
  4. New or worsening pericardial effusion Supportive findings: elevated inflammatory markers, CT/CMR evidence of inflammation. Source: Fuster and Hurst's The Heart, 15th ed.

5) Aortic Dissection

Defined by an intimal tear allowing pressurized blood into the aortic media, creating true and false lumens. Type A involves ascending aorta; Type B involves descending aorta. A life-threatening acute aortic syndrome. Source: Goldman-Cecil Medicine.

6) Aortic Stenosis

Obstruction at the aortic valve causing left ventricular outflow limitation and transvalvular pressure gradient. Severe disease classically presents with angina, syncope, and heart failure. Sources: Creasy and Resnik's Maternal-Fetal Medicine; Fuster and Hurst's The Heart.

7) Hypertrophic Cardiomyopathy (HCM)

Defined as unexplained left ventricular hypertrophy not accounted for by abnormal loading conditions (e.g., hypertension, valvular disease, congenital defects). Source: Goldman-Cecil Medicine.

8) Mitral Valve Prolapse (MVP)

Systolic displacement of one or both mitral leaflets beyond the annular plane into the left atrium, often associated with mid-systolic click and atypical chest pain.

9) Myocarditis

Inflammation of myocardium, often post-viral, with chest pain, troponin elevation, and ECG abnormalities.

II. Gastrointestinal Causes

10) Gastroesophageal Reflux Disease (GERD)

GERD occurs when reflux of gastric contents into the esophagus causes troublesome symptoms or complications. Source: Goldman-Cecil Medicine.

11) Esophageal Spasm / Motility Disorders

Uncoordinated or hypercontractile esophageal contractions causing severe substernal chest pain and dysphagia; may mimic ACS.

12) Peptic Ulcer Disease (PUD)

Mucosal break in stomach or duodenum extending through muscularis mucosa, due to imbalance between protective and injurious factors (e.g., acid, pepsin, H. pylori, NSAIDs).

13) Biliary Colic / Cholecystitis

Biliary colic: episodic RUQ/epigastric pain from transient cystic duct obstruction by gallstone. Acute cholecystitis: gallbladder inflammation usually due to persistent cystic duct obstruction.

14) Pancreatitis

Acute pancreatic inflammation causing severe epigastric pain radiating to back/chest with nausea/vomiting and elevated pancreatic enzymes.

15) Esophageal Perforation (Boerhaave Syndrome)

Spontaneous full-thickness esophageal rupture (often after forceful emesis) causing severe chest pain, mediastinal contamination, and high mortality if delayed.

III. Musculoskeletal Causes

16) Costochondritis (Tietze Syndrome)

Inflammation of costochondral junctions causing localized chest wall pain reproducible on palpation. Tietze includes visible swelling of costal cartilage.

17) Chest Wall Muscle Strain / Rib Fracture

Mechanical chest wall pain from muscle injury or rib cortical disruption, worsened by movement/palpation/coughing.

18) Intercostal Neuritis / Radiculitis (Herpes Zoster)

Neuropathic dermatomal pain from intercostal nerve irritation; zoster classically causes unilateral burning pain preceding vesicular rash.

19) Cervical/Thoracic Spine Disorders (Cervical Radiculopathy)

Nerve root compression (often C4-T1 referral patterns) causing chest/arm pain, provoked by neck movement, with possible neurologic deficits.

20) Ankylosing Spondylitis

Chronic inflammatory axial spondyloarthropathy causing spinal stiffness, sacroiliitis, and reduced chest wall expansion.

21) Thoracic Outlet Syndrome

Compression of brachial plexus/subclavian vessels at thoracic outlet causing chest/shoulder/arm pain with neurovascular symptoms.

IV. Psychogenic / Psychiatric Causes

22) Panic Disorder / Panic Attack

Panic attacks have abrupt onset, peak within minutes, and include intense fear with autonomic symptoms (palpitations, dyspnea, chest tightness, dizziness, sweating). Panic disorder is recurrent unexpected attacks with persistent concern/behavioral change. Source: Kaplan and Sadock's Synopsis of Psychiatry.

23) Generalized Anxiety Disorder (GAD)

Excessive difficult-to-control worry across domains for at least 6 months, with somatic tension symptoms that can include chest tightness and hyperventilation-related discomfort.

24) Depression / Somatization

Psychological distress expressed as persistent physical symptoms without sufficient structural pathology, often with mood, sleep, and fatigue features.

25) Functional Chest Pain of Esophageal Origin

Rome IV functional esophageal disorder characterized by recurrent retrosternal pain without evidence of GERD, eosinophilic esophagitis, or major motility disorder after appropriate evaluation.

High-Yield Clinical Approach

  1. Exclude immediate threats first: ACS, aortic dissection, PE, tension pneumothorax, esophageal perforation.
  2. Focused history: onset, quality, location, radiation, triggers, relieving factors, associated symptoms.
  3. Focused exam: bilateral blood pressure, cardiovascular and respiratory exam, chest wall palpation, neurologic screening.
  4. ECG immediately in all acute chest pain.
  5. Serial troponins (0 and 3 hours or per protocol).
  6. Chest imaging as indicated (CXR, CTA, focused ultrasound).
  7. Targeted downstream testing for GI, musculoskeletal, and psychiatric etiologies when cardiac/life threats are excluded.

Sources

Goldman-Cecil Medicine; Fuster and Hurst's The Heart (15th ed.); Sabiston Textbook of Surgery; Swanson's Family Medicine Review; Goodman and Gilman's Pharmacological Basis of Therapeutics; Kaplan and Sadock's Synopsis of Psychiatry; Creasy and Resnik's Maternal-Fetal Medicine; Rosen's Emergency Medicine; Yamada's Textbook of Gastroenterology; Murray and Nadel's Respiratory Medicine.
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