Differential Diagnosis
- Single most likely diagnosis
- Anxiety disorder: The patient's history of anxiety episodes, persistent non-specific chest pain, and palpitations despite multiple negative cardiac workups, along with the recent anxiety attack, suggest that anxiety is a significant contributor to his symptoms. The patient's willingness to try anxiety medication also supports this diagnosis.
- Other Likely diagnoses
- Hyperventilation syndrome: The patient's symptoms of pleuritic chest pain, chest tightness, tachycardia, and shortness of breath are consistent with hyperventilation syndrome, which can be triggered by anxiety.
- Somatization disorder: The patient's multiple ED visits for similar complaints, despite negative workups, suggest that he may be experiencing somatization of his anxiety, where physical symptoms are a manifestation of psychological distress.
- Asthma exacerbation: Although the patient's asthma is a known condition, his recent symptoms of congestion and cough could indicate an exacerbation, which may be contributing to his chest pain and shortness of breath.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Pulmonary embolism: Although the patient's chest x-ray shows clear lungs, pulmonary embolism can present with non-specific symptoms, including chest pain and shortness of breath, and would be a deadly diagnosis if missed.
- Cardiac arrhythmia: Despite the patient's normal echocardiogram, cardiac arrhythmias can occur in young people, and his symptoms of palpitations and tachycardia warrant consideration of this diagnosis.
- Pneumothorax: The patient's pleuritic chest pain and shortness of breath could indicate a pneumothorax, which would require immediate attention.
- Rare diagnoses
- Pheochromocytoma: The patient's symptoms of palpitations, tachycardia, and hypertension (although not explicitly mentioned) could suggest pheochromocytoma, a rare tumor of the adrenal gland that can cause episodic symptoms.
- Hypercoagulable state: The patient's elevated hemoglobin and hematocrit, along with positive IgG, may indicate a hypercoagulable state, which could increase his risk of thrombotic events, including pulmonary embolism.