Differential Diagnosis for Acute Chest Pain Episodes
The patient's complex medical history and episodic symptoms require a thorough evaluation of potential causes. The following differential diagnosis is organized into categories to facilitate consideration of possible explanations.
- Single Most Likely Diagnosis
- Migraine with aura: The patient's symptoms of acute chest pain, flushing, numbness, tingling, and weakness, occurring semi-weekly, could be indicative of migraine with aura. The presence of lupus and antiphospholipid antibody syndrome may contribute to an increased risk of migraine. The episodic nature and combination of symptoms make this a plausible explanation.
- Other Likely Diagnoses
- Vasospastic episodes: The patient's history of factor V Leiden and antiphospholipid antibody syndrome may predispose them to vasospastic episodes, which could cause chest pain, numbness, and tingling.
- Lupus flare-ups: The patient's lupus diagnosis could be contributing to the episodic symptoms, particularly if the disease is not well-controlled.
- Anxiety or panic attacks: The patient's symptoms, such as chest pain and numbness, could be indicative of anxiety or panic attacks, especially given the frequency and episodic nature of the events.
- Do Not Miss Diagnoses
- Pulmonary embolism: Although coronary causes have been ruled out, pulmonary embolism remains a critical consideration, especially given the patient's history of factor V Leiden and antiphospholipid antibody syndrome.
- Cardiac sarcoidosis: This condition can cause chest pain, numbness, and tingling, and is a potential complication of lupus.
- Neurological disorders: Conditions like multiple sclerosis or peripheral neuropathy could be contributing to the patient's symptoms, particularly numbness, tingling, and weakness.
- Rare Diagnoses
- Ehlers-Danlos syndrome: This genetic disorder can cause vasospastic episodes, joint hypermobility, and other symptoms that may be relevant to the patient's presentation.
- Pheochromocytoma: Although rare, this condition can cause episodic hypertension, chest pain, and other symptoms that may be relevant to the patient's presentation, particularly given the familial history of neurofibromatosis.
- Mitochondrial myopathies: These rare genetic disorders can cause episodic weakness, numbness, and tingling, and may be considered in the differential diagnosis.