Differential Diagnosis
The patient's symptoms of tachycardia on movement, chest heaviness, feeling of air not getting into the lungs, and a weaker left carotid pulse suggest a cardiovascular issue. Here are the possible diagnoses, categorized for clarity:
Single Most Likely Diagnosis
- Aortic Dissection: This condition, where the inner layer of the aorta tears, can lead to tachycardia, chest pain (heaviness), and shortness of breath. The discrepancy in carotid pulses is a classic sign, as the dissection can affect blood flow to the carotid arteries differently.
Other Likely Diagnoses
- Cardiac Ischemia/Myocardial Infarction: Reduced blood flow to the heart muscle can cause chest heaviness, shortness of breath, and tachycardia. Although the weaker carotid pulse is less typical, it could be related to a more complex cardiac issue.
- Pulmonary Embolism: A blockage in one of the pulmonary arteries can cause sudden onset of shortness of breath, chest pain, and tachycardia. However, the difference in carotid pulses is not a common finding.
- Hypertrophic Cardiomyopathy: This condition can lead to obstructive symptoms, including chest pain and shortness of breath, especially with exertion. Tachycardia can also occur, but the carotid pulse discrepancy is not a hallmark sign.
Do Not Miss Diagnoses
- Aortic Stenosis: Although less likely given the specific combination of symptoms, severe aortic stenosis can cause exertional chest pain, shortness of breath, and syncope. The difference in carotid pulses could be due to associated aortic disease.
- Subclavian Steal Syndrome: This rare condition involves reversal of blood flow in the vertebral artery due to stenosis or occlusion of the subclavian artery, which could explain the weaker carotid pulse on one side. However, it's less commonly associated with the other symptoms described.
- Pneumothorax: A collapsed lung can cause sudden shortness of breath and chest pain, and if large enough, could lead to tachycardia and decreased pulses due to decreased cardiac output.
Rare Diagnoses
- Takayasu Arteritis: A large vessel vasculitis that can affect the aorta and its major branches, potentially leading to discrepancies in peripheral pulses, including carotid pulses. It's a rare condition but could explain the combination of symptoms.
- Coarctation of the Aorta: A congenital narrowing of the aorta that could lead to differential blood pressures in the arms and weaker pulses in the lower extremities. However, it's less likely to present for the first time in adulthood with the exact symptoms described.