Differential Diagnosis
The patient presents with symptoms of feeling "high" without stimulant use, left-sided chest pressure, and left arm numbness and tingling. Here's a categorized differential diagnosis:
- Single most likely diagnosis
- Anxiety or Panic Disorder: The feeling of being "high" could be related to anxiety or panic attacks, which can also cause chest pressure and numbness or tingling sensations in the arms due to hyperventilation and increased stress response.
- Other Likely diagnoses
- Hyperventilation Syndrome: Similar to anxiety, hyperventilation can lead to feelings of lightheadedness or being "high," along with chest pressure and arm numbness due to respiratory alkalosis.
- Musculoskeletal Issues (e.g., Costochondritis, Tendonitis): These conditions could explain the chest pressure and arm numbness or tingling, especially if the patient has a history of physical activity or trauma.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Myocardial Infarction (MI) or Acute Coronary Syndrome: Although less likely given the "high" feeling, chest pressure, especially on the left side, and arm numbness or tingling are classic symptoms of a heart attack, which requires immediate medical attention.
- Pulmonary Embolism: Sudden onset of chest pressure and arm symptoms could be indicative of a pulmonary embolism, especially if accompanied by shortness of breath or other respiratory symptoms.
- Stroke or Transient Ischemic Attack (TIA): Numbness or tingling, particularly on one side of the body, can be a sign of a stroke or TIA, which is a medical emergency.
- Rare diagnoses
- Multiple Sclerosis: This condition can cause numbness or tingling in various parts of the body, including the arms, but would typically be accompanied by other neurological symptoms.
- Thoracic Outlet Syndrome: Compression of the nerves or blood vessels that pass into the thoracic outlet (the space between your collarbone and first rib) can cause numbness or tingling in the arms, but this would usually be related to specific postures or activities.
- Pheochromocytoma: A rare tumor of the adrenal gland that can cause episodes of high blood pressure, palpitations, and a feeling of being "high" or anxious, but this would typically be accompanied by other systemic symptoms like headaches or sweating.