Differential Diagnosis for Chest Pain, Palpitation, and Dizziness

The patient's symptoms of chest pain, palpitation, and dizziness, which resolved after stopping Flomax, suggest a multifactorial etiology. Here's a categorized differential diagnosis:

• Single Most Likely Diagnosis
  • Anxiety Attack: The patient's self-reported suspicion of an anxiety attack, coupled with the resolution of symptoms after stopping a medication (Flomax) that can cause dizziness as a side effect, supports this diagnosis. The normal EKG further points towards a non-cardiac cause.
• Other Likely Diagnoses
  • Orthostatic Hypotension: Stopping Flomax, an alpha-blocker known to cause orthostatic hypotension, and the resolution of dizziness and lightheadedness, make this a plausible explanation.
  • Hypertension: Although not directly linked to the symptoms described, hypertension can cause palpitations and is a common condition in this age group. The recent episode could be unrelated but warrants consideration.
• Do Not Miss Diagnoses
  • Cardiac Arrhythmias (e.g., Atrial Fibrillation): Although the EKG was normal, arrhythmias can be intermittent. Missing a diagnosis of a significant arrhythmia could have serious consequences.
  • Myocardial Ischemia: Despite the normal EKG, myocardial ischemia (especially if the EKG was done after the episode resolved) needs to be considered, as it is a life-threatening condition.
  • Pulmonary Embolism: This condition can present with chest pain, palpitations, and dizziness. Although less likely given the resolution of symptoms, it's critical not to miss due to its high mortality rate.
• Rare Diagnoses
  • Pheochromocytoma: A rare tumor of the adrenal gland that can cause episodic hypertension, palpitations, and dizziness. The resolution of symptoms after stopping Flomax makes this less likely, but it remains a consideration in the differential diagnosis.
  • Cardiac Valve Problems: Conditions like mitral valve prolapse can cause palpitations and chest discomfort. These are less likely given the normal EKG but could be considered if other symptoms persist or recur.

Each of these diagnoses should be considered in the context of the patient's full medical history, physical examination, and further diagnostic testing as indicated.