Differential Diagnosis for Chest Discomfort Radiating into the Neck with Dizziness
Single Most Likely Diagnosis
- Acute Coronary Syndrome (ACS): This is the most likely diagnosis due to the classic presentation of chest discomfort radiating to the neck, which is a common symptom of myocardial infarction (MI) or unstable angina. The addition of dizziness could indicate decreased cardiac output or arrhythmias associated with ACS.
Other Likely Diagnoses
- Gastroesophageal Reflux Disease (GERD): GERD can cause chest discomfort that may radiate to the neck and can be associated with dizziness if the pain is severe enough to cause vasovagal symptoms.
- Musculoskeletal Pain: Musculoskeletal issues, such as costochondritis or cervical spine strain, can cause chest and neck pain. Dizziness could be related to pain-induced stress or muscle spasm.
- Pulmonary Embolism (PE): While less common, PE should be considered, especially if there are risk factors such as recent travel, immobilization, or family history of clotting disorders. Dizziness could be due to hypoxia or decreased cardiac output.
Do Not Miss Diagnoses
- Aortic Dissection: A life-threatening condition that presents with severe, tearing chest pain radiating to the neck and can cause dizziness due to decreased blood flow to the brain or cardiac complications. It's crucial to consider this diagnosis despite its lower likelihood.
- Cardiac Tamponade: Accumulation of fluid in the pericardial sac can compress the heart, leading to decreased cardiac output, which may cause chest discomfort, neck pain, and dizziness.
- Pneumothorax: A collapsed lung can cause chest pain and shortness of breath, potentially leading to dizziness due to hypoxia. The pain can radiate to the neck.
Rare Diagnoses
- Esophageal Spasm or Rupture: These conditions can cause severe chest pain that may radiate to the neck. Dizziness could occur due to pain or, in the case of rupture, due to hypovolemic shock.
- Cervical Vertebral Artery Dissection: A rare cause of neck pain and dizziness due to potential stroke or vertebral artery insufficiency.
- Thyroid Storm: A life-threatening complication of untreated or undertreated hyperthyroidism, which can cause chest discomfort, neck pain (due to thyroid gland location), and systemic symptoms including dizziness.