Differential Diagnosis

The patient presents with a complex array of symptoms including rapid heart rate, shortness of breath, feeling of fainting, forearm nerve irritation, and chest pain, set against a background of chronic generalized anxiety disorder (GAD), stress, medication use (Adderall), dehydration, poor diet, and a history of smoking and anorexia. The following differential diagnoses are organized into categories based on their likelihood and potential impact:

• Single Most Likely Diagnosis
  • Panic Attack or Anxiety-Related Symptoms: Given the patient's history of chronic GAD, recent stress, and symptoms such as rapid heart rate, shortness of breath, and feelings of fainting, a panic attack or exacerbation of anxiety symptoms is highly plausible. The patient's description of hyperawareness and intense lights also aligns with sensory sensitivities often reported during panic attacks.
• Other Likely Diagnoses
  • Dehydration: The patient admits to usually being dehydrated, which can cause symptoms like rapid heart rate, fatigue, and dizziness. Dehydration can exacerbate feelings of anxiety and contribute to physical symptoms.
  • Hyperventilation Syndrome: This condition, often associated with anxiety, involves rapid and deep breathing, leading to symptoms like lightheadedness, palpitations, and chest tightness. The patient's mention of automatic breath holding and then presumably breathing rapidly could contribute to this condition.
  • Vitamin Deficiencies: Given the patient's history of anorexia and current poor diet, deficiencies in vitamins such as B12 or D could contribute to fatigue, weakness, and possibly neurological symptoms like nerve irritation.
• Do Not Miss Diagnoses
  • Cardiac Issues (e.g., Arrhythmias, Myocardial Infarction): Although the patient's blood pressure has always been great and a previous EKG was okay, cardiac issues must be considered, especially given the chest pain and previous concerns that led to a hospital visit. The patient's smoking history and potential for high cholesterol increase cardiovascular risk.
  • Pulmonary Embolism: This is a critical diagnosis to consider, especially with symptoms like shortness of breath and chest pain. Although less likely, it is potentially life-threatening and requires immediate medical attention.
  • Asthma or Chronic Obstructive Pulmonary Disease (COPD): Given the patient's smoking history and symptoms like shortness of breath and production of phlegm, pulmonary diseases should be considered, especially with a family history of asthma.
• Rare Diagnoses
  • Pheochromocytoma: A rare tumor of the adrenal gland that could cause episodes of rapid heart rate, sweating, and hypertension, although the patient's blood pressure has been consistently good.
  • Mitral Valve Prolapse: A condition that can cause palpitations, chest pain, and anxiety-like symptoms, though it would be less likely without a history of murmurs or previous cardiac issues.

Given the complexity of the patient's presentation, a thorough medical evaluation is necessary to determine the underlying cause(s) of the symptoms. Urgent care or an emergency department visit could provide immediate assessment and treatment, including hydration, and potentially refer the patient to a primary care physician for ongoing management and further investigation into chronic issues like vitamin deficiencies and pulmonary health.