Differential Diagnosis

• Single most likely diagnosis
  • Anxiety disorder: The patient's history of anxiety attacks, persistent worry about his health, and the ineffectiveness of current anxiety medications suggest that an anxiety disorder is the most likely diagnosis. The patient's symptoms of dizziness, chest pain, and shortness of breath may be exacerbated or triggered by anxiety.
• Other Likely diagnoses
  • Asthma exacerbation or poorly controlled asthma: The patient's history of severe persistent asthma, recent increased use of inhalers, and persistent symptoms such as chest tightness and shortness of breath suggest that his asthma may not be well-controlled.
  • Allergic disorder: The patient's significantly elevated IgE levels and history of allergy symptoms (congestion and cough) suggest an allergic disorder, which may be contributing to his respiratory symptoms.
  • Hyperventilation syndrome: The patient's symptoms of dizziness, chest pain, and shortness of breath, particularly in the context of anxiety, may be consistent with hyperventilation syndrome.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
  • Cardiac conditions (e.g., cardiomyopathy, arrhythmias): Although the patient has had a normal echocardiogram, it is essential to consider cardiac conditions, given his symptoms of chest pain, tachycardia, and shortness of breath.
  • Pulmonary embolism: The patient's symptoms of pleuritic chest pain, shortness of breath, and tachycardia, although persistent, could be indicative of a pulmonary embolism, which would require immediate attention.
  • Hematologic disorders (e.g., polycythemia vera): The patient's previously elevated hemoglobin and hematocrit levels, as well as his referral to hematology-oncology, suggest that a hematologic disorder should be considered.
• Rare diagnoses
  • Vasovagal syncope: The patient's new symptom of dizziness when moving his head could be consistent with vasovagal syncope, although this would be a less likely diagnosis given his other symptoms.
  • Inner ear disturbances (e.g., benign paroxysmal positional vertigo): The patient's symptom of dizziness when moving his head may be related to an inner ear disturbance, although this would not explain his other symptoms.
  • Eosinophilic granulomatosis with polyangiitis (Churg-Strauss syndrome): The patient's significantly elevated IgE levels, asthma, and history of allergy symptoms could be consistent with Churg-Strauss syndrome, although this would be a rare diagnosis.