The Differential Diagnosis of Acute Chest Pain (Hebrews 4:15-16)

Every physician can recite the differential diagnosis of acute chest pain. Many of the diseases are familiar to lay people. One way to organize the diseases is by organ system. For example, an abbreviated list may include cardiac or heart causes such as a myocardial infarction or heart attack, a dissecting aortic aneurysm, or pericarditis, an inflammation of the membranes surrounding the heart. Gastrointestinal causes may include reflux or heartburn, or an ulcer of the stomach or esophagus. Think of all the body parts in the chest and there will be an accompanying disease. So, it will come as no surprise that the skin may also have diseases that are included in the differential diagnosis of acute chest pain. The most common condition is shingles. While this made intellectual sense to me when I first learned it, I never seriously considered it in my differential diagnoses. There were so many other life threatening conditions that shingles seemed to be an afterthought.


Shingles is a reactivation of the virus that causes chicken pox. If you have been afflicted with this disease, believe me, I feel your pain. I have had two previous episodes, both exquisitely painful. The first episode was memorable because the outbreak occurred on my chest wall, directly overlying my heart. It felt like an ice pick was being driven into my heart. At that moment, I viscerally understood, for the first time, why shingles is included in the differential diagnosis of acute chest pain! My approach to patients changed after my own experience. Once I experienced the pain and suffering of my patients, it made me become a better physician with a greater empathy.


For we do not have a high priest who is unable to sympathize with our weaknesses, but one who in every respect has been tempted as we are, yet without sin. Let us then with confidence draw near to the throne of grace, that we may receive mercy and find grace to help in time of need.

Hebrews 4:15-16 (ESV)


Jesus Christ is the Great Physician. He understands our deepest fears, our most difficult struggles, and most searing pains. He experienced an eternity of suffering when He died on the Cross for our sins. At that moment, all of the sins of mankind-past, present, and future, were inflicted upon Him. He took the punishment that we deserved and conquered death by His resurrection. Because of this, I know that Jesus understands all of the pain I have experienced or ever will experience. I can come to Him with confidence, knowing that He knows exactly what is happening to me.


Like my own case of shingles helped me to better understand my patients and gain their trust, the sacrifice of Jesus Christ on the Cross will always enable me to trust His Word and promises.




Love and trust the Lord; seek His will in your life.