Differential Diagnosis for Chest Pain with Associated Symptoms

The patient's symptoms of sharp chest pain, numbness in the upper extremity, and bright/whitening of vision after a short walk suggest a complex interplay of cardiovascular, neurological, and possibly ophthalmological factors. Here's a categorized differential diagnosis:

• Single Most Likely Diagnosis

  • Angina Pectoris with Associated Neurological Symptoms: This could be the most likely diagnosis given the chest pain triggered by exertion (a short walk). The numbness in the upper extremity and visual disturbances could be related to decreased cardiac output or vasospasm affecting multiple vascular beds, including cerebral and ocular vessels.

• Other Likely Diagnoses

  • Thoracic Outlet Syndrome (TOS): This condition involves compression, injury, or irritation of the nerves and/or blood vessels (arteries and veins) in the thoracic outlet area, which lies between your collarbone (clavicle) and first rib. It could explain the numbness in the upper extremity and possibly the chest pain if there's associated vascular compression.
  • Migraine with Aura: Although typically associated with headache, migraines can have a wide range of neurological symptoms, including visual disturbances (aura) and possibly numbness. The chest pain could be unrelated or part of a migraine equivalent.
  • Vasovagal Syncope: This condition is characterized by a sudden drop in heart rate and blood pressure, often triggered by stress or pain, leading to reduced blood flow to the brain and potentially causing visual disturbances and numbness.

• Do Not Miss Diagnoses

  • Myocardial Infarction (MI): Although the chest pain is described as sharp and only 3/10, MI can present atypically, especially in women, diabetics, and the elderly. The exertional trigger increases suspicion.
  • Aortic Dissection: A life-threatening condition where there is a tear in the aorta's inner layer. It can cause severe, tearing chest pain and, depending on the branches involved, could lead to neurological symptoms due to compromised blood flow.
  • Pulmonary Embolism (PE): Can cause sudden onset of chest pain, especially with exertion, and while less likely to cause the described neurological symptoms directly, it's a critical diagnosis not to miss due to its high mortality rate if untreated.
  • Transient Ischemic Attack (TIA) or Stroke: Although the symptoms might not fit a classic stroke pattern, TIAs can have varied presentations, including visual disturbances and numbness, and are a medical emergency.

• Rare Diagnoses

  • Subclavian Steal Syndrome: A rare condition where there's a significant stenosis or occlusion of the subclavian artery proximal to the origin of the vertebral artery, leading to reversal of blood flow in the vertebral artery. This could cause neurological symptoms due to decreased blood flow to the brain.
  • Ocular Migraine: A condition that can cause temporary, painless visual disturbances, including blindness or bright/whitening of vision, but it's less likely to be associated with chest pain and numbness in the upper extremity.