Differential Diagnosis for a 56-year-old Female with Heartburn, Dizziness, and Left Arm Pain
Single Most Likely Diagnosis
- Gastroesophageal reflux disease (GERD) with associated symptoms: This is the most likely diagnosis given the patient's symptoms of heartburn, which is a classic presentation of GERD. The dizziness could be related to GERD through mechanisms such as vagal response or decreased blood volume from vomiting, and the left arm pain might be referred pain from the chest or a musculoskeletal issue.
Other Likely Diagnoses
- Musculoskeletal strain or injury: The left arm pain could be due to a strain or injury, especially if the patient has been engaging in unusual physical activity. This could also contribute to or exacerbate feelings of dizziness if the patient is experiencing pain or discomfort that leads to decreased mobility or position changes.
- Anxiety or panic disorder: These conditions can present with a wide range of symptoms including chest discomfort (mistaken for heartburn), dizziness, and arm pain due to muscle tension. The occasional nature of the left arm pain might suggest a non-cardiac cause.
- Peptic ulcer disease: Similar to GERD, peptic ulcers can cause heartburn and, if complicated, could lead to symptoms like dizziness due to anemia from chronic blood loss. However, left arm pain would be less directly related unless considering referred pain.
Do Not Miss Diagnoses
- Acute coronary syndrome (ACS) or myocardial infarction (MI): Although the presentation might not be typical (especially with heartburn being a prominent symptom), it's crucial not to miss cardiac causes of chest pain and arm pain, as these conditions are life-threatening and require immediate intervention. Dizziness could be a symptom of decreased cardiac output.
- Pulmonary embolism: This condition can cause sudden onset of dizziness and chest pain, and while less likely given the heartburn, it's a diagnosis that cannot be missed due to its high mortality rate if untreated.
Rare Diagnoses
- Esophageal spasm or achalasia: These are motility disorders of the esophagus that could cause chest pain and heartburn. While they are less common, they could explain some of the patient's symptoms, especially if the left arm pain is referred from the chest.
- Thoracic outlet syndrome: This condition involves compression of the nerves and/or blood vessels that pass into the thoracic outlet (the space between your collarbone and first rib). It could cause arm pain and potentially some chest symptoms, though it's less likely to cause heartburn directly.