Differential Diagnosis for Intermittent Left Arm, Shoulder, Chest, and Face Pain
Single Most Likely Diagnosis
- Angina Pectoris: This condition is characterized by chest pain or discomfort due to transient myocardial ischemia. The pain can radiate to the left arm, shoulder, and even the face, especially the jaw. The intermittent nature of the pain and its distribution make angina a strong candidate for the single most likely diagnosis.
Other Likely Diagnoses
- Musculoskeletal Pain: Conditions such as costochondritis (inflammation of the cartilage that connects the ribs to the breastbone) or musculoskeletal strain can cause pain in the chest, arm, and shoulder. These conditions are relatively common and can mimic cardiac pain.
- Gastroesophageal Reflux Disease (GERD): GERD can cause chest pain that may radiate to the arm and shoulder. The pain is often worsened by lying down or eating certain foods.
- Cervical Radiculopathy: Compression or irritation of the nerves in the cervical spine can cause pain that radiates down the arm and can also refer pain to the chest and face.
Do Not Miss Diagnoses
- Myocardial Infarction (MI): Although the pain is intermittent, it's crucial not to miss an MI, as timely intervention is critical for outcomes. MI can present with a variety of symptoms, including chest pain that radiates to the arm, shoulder, and jaw.
- Aortic Dissection: This is a life-threatening condition where there is a tear in the aorta's inner layer. It can cause severe, tearing chest pain that radiates to the back and can also cause arm and shoulder pain.
- Pulmonary Embolism: While more commonly associated with respiratory symptoms, pulmonary embolism can cause chest pain that may radiate to the arm and shoulder, especially if it involves the pulmonary infarction.
Rare Diagnoses
- Thoracic Outlet Syndrome: This condition involves compression of the nerves and/or blood vessels that pass into the thoracic outlet (the space between your collarbone and first rib). It can cause pain in the shoulders and neck and can radiate down the arm.
- Esophageal Spasm: Spasms of the esophagus can cause chest pain that may mimic cardiac pain and can radiate to the arm and shoulder.
- Glossopharyngeal Neuralgia: This is a rare condition characterized by recurrent episodes of severe pain in the tongue, throat, ear, and face. It's less likely to cause arm and shoulder pain but can be considered in the differential for face pain.