Differential Diagnosis for Patient Complaint

The patient complains of a "thousand needle stickering" sensation after a fall and has a history of coronary artery disease (CAD). Here's a differential diagnosis organized into categories:

• Single Most Likely Diagnosis

  • Acute Coronary Syndrome (ACS): The sensation of "a thousand needle stickering" could be descriptive of chest pain or discomfort, which is a common presentation of ACS, especially in a patient with a history of CAD. The recent fall could be a trigger for increased stress or physical exertion, leading to an ACS event.

• Other Likely Diagnoses

  • Anxiety or Panic Attack: The description could also fit the sensation of anxiety or a panic attack, which might be triggered by the fall or could be unrelated but exacerbated by the stress of the event.
  • Musculoskeletal Injury: The fall could have resulted in a musculoskeletal injury, such as bruising or muscle strain, which might cause a prickling or stabbing sensation, especially if the patient is experiencing referred pain.
  • Peripheral Neuropathy: If the patient has underlying diabetes or another condition leading to peripheral neuropathy, the fall might have exacerbated symptoms, leading to a sensation that could be described as "a thousand needle stickering."

• Do Not Miss Diagnoses

  • Myocardial Infarction (MI): A critical diagnosis to not miss, as timely intervention is crucial for outcomes. The history of CAD and the nature of the complaint make this a high-priority consideration.
  • Pulmonary Embolism (PE): Especially if the fall resulted in immobilization or if the patient has other risk factors for PE, this diagnosis could present with chest pain or discomfort and must be considered due to its high mortality rate if untreated.
  • Cardiac Tamponade: Although less likely, if the fall resulted in trauma to the chest, cardiac tamponade could be a life-threatening condition presenting with chest pain or discomfort.

• Rare Diagnoses

  • Complex Regional Pain Syndrome (CRPS): This condition could result from the fall, especially if there was an injury to a limb, and might present with a variety of sensations including burning, aching, or a prickling feeling.
  • Neurological Conditions (e.g., Multiple Sclerosis, Neuropathies): Certain neurological conditions could present with unusual sensations, but these would be less directly related to the fall and more related to an underlying condition.

Each of these diagnoses requires careful consideration of the patient's history, physical examination, and potentially, further diagnostic testing to determine the cause of the symptoms.