Differential Diagnosis for a 50-year-old Male with Chronic Alcoholism

Single Most Likely Diagnosis

• Alcoholic Cardiomyopathy with Withdrawal Symptoms: Given the patient's history of chronic alcoholism and recent cessation, the combination of chest tightness, anxiety, and hypokalemia could be attributed to alcoholic cardiomyopathy, a condition where long-term alcohol abuse leads to heart muscle damage. The symptoms could also be exacerbated by withdrawal effects, which can include anxiety and potentially contribute to cardiac issues.

Other Likely Diagnoses

• Hypokalemic Cardiomyopathy: Hypokalemia can lead to cardiac arrhythmias and muscle weakness. In the context of recent alcohol cessation and a poor diet, hypokalemia could be a significant contributor to the patient's symptoms, potentially leading to or exacerbating cardiomyopathy.
• Alcohol Withdrawal Syndrome: Although the patient stopped drinking a month ago, some symptoms of alcohol withdrawal can persist or recur, including anxiety and potentially chest tightness due to autonomic instability.
• Nutritional Deficiencies: Chronic alcoholism often leads to poor dietary habits and malabsorption, resulting in deficiencies such as thiamine (Vitamin B1) deficiency, which can cause cardiovascular issues, among other problems.

Do Not Miss Diagnoses

• Myocardial Infarction (MI): Chest tightness is a classic symptom of MI. Given the patient's age and history of alcoholism (which increases cardiovascular risk), it's crucial to rule out an MI, even though the patient's symptoms might seem atypical or attributed to other causes.
• Pulmonary Embolism (PE): Anxiety and chest tightness could also be symptoms of a PE, especially in a patient with potential for dehydration and immobilization due to alcohol withdrawal.
• Arrhythmias: Hypokalemia and alcohol withdrawal can predispose to various arrhythmias, some of which can be life-threatening if not promptly addressed.

Rare Diagnoses

• Beriberi: A condition caused by thiamine deficiency, which can lead to cardiovascular symptoms, including chest pain and heart failure. While less common, it's a consideration in chronic alcoholics with poor nutrition.
• Pellagra: Caused by niacin deficiency, it can lead to dermatitis, diarrhea, dementia, and potentially death if not treated. Cardiovascular symptoms can be part of the presentation, although it's less directly linked to the patient's current complaints.