Differential Diagnosis

The patient presents with two distinct episodes: gastrointestinal symptoms followed by an episode of dizziness, double vision, heart palpitations, and chest pressure. Here's a categorized differential diagnosis:

• Single Most Likely Diagnosis

  • Viral gastroenteritis for the initial symptoms, given the acute onset of vomiting and diarrhea without fever or other systemic symptoms, which resolved with supportive care.
  • For the second episode, anxiety or panic attack is a strong consideration, especially given the patient's history of heart palpitations and the presence of dizziness, double vision, and chest pressure without any reported precipitating factors or persistent symptoms.

• Other Likely Diagnoses

  • Gastrointestinal infection (e.g., food poisoning) for the initial symptoms.
  • Dehydration as a complication of the gastrointestinal symptoms, potentially contributing to the dizziness.
  • Vasovagal syncope or orthostatic hypotension for the dizziness and palpitations, especially if the patient was standing or changed positions rapidly before the episode.
  • Benign paroxysmal positional vertigo (BPPV) for the double vision, though this typically presents with vertigo and is triggered by specific head movements.

• Do Not Miss Diagnoses

  • Myocardial infarction or acute coronary syndrome: Although less likely given the patient's age and the transient nature of the symptoms, chest pressure and palpitations are cardinal symptoms that cannot be ignored.
  • Arrhythmias (e.g., atrial fibrillation, supraventricular tachycardia): Given the history of heart palpitations, an arrhythmic cause for the symptoms must be considered.
  • Pulmonary embolism: Though the patient denies cough or shortness of breath, the sudden onset of chest pressure and palpitations could be indicative of a pulmonary embolism, especially if there were recent periods of immobility or other risk factors.
  • Stroke or transient ischemic attack (TIA): Double vision and dizziness could be symptoms of a stroke or TIA, particularly if there were associated focal neurological deficits.

• Rare Diagnoses

  • Pheochromocytoma: A rare tumor of the adrenal gland that can cause episodic hypertension, palpitations, and other symptoms due to excessive catecholamine release.
  • Cardiac channelopathies (e.g., long QT syndrome): These are rare conditions that affect the heart's electrical system and can cause palpitations, syncope, and even sudden death.
  • Neurological disorders (e.g., multiple sclerosis, vestibular migraine): Though less likely, these conditions could potentially explain some of the patient's symptoms, particularly the double vision and dizziness.