Differential Diagnosis for a 31-year-old Male with Stage 1 Hypertension and Complete Right Bundle Branch Block (RBBB), Normal Sinus Rhythm (NSR)
- Single Most Likely Diagnosis
- Hypertensive heart disease: This is the most likely diagnosis given the patient's stage 1 hypertension. The complete RBBB can be an incidental finding or related to the hypertension, which may cause left ventricular hypertrophy and subsequently affect the conduction system of the heart.
- Other Likely Diagnoses
- Idiopathic or congenital RBBB: Some individuals may have a congenital or idiopathic RBBB without any underlying cardiac disease. The presence of stage 1 hypertension may be coincidental.
- Cardiomyopathy (e.g., hypertrophic cardiomyopathy): Although less common, cardiomyopathies can cause both hypertension and conduction abnormalities, including RBBB.
- Do Not Miss Diagnoses
- Coronary artery disease (CAD): Although less common in a 31-year-old, CAD should not be missed, especially if there are other risk factors present. CAD can cause hypertension and conduction abnormalities.
- Cardiac sarcoidosis: This condition can cause conduction abnormalities, including RBBB, and may also lead to hypertension due to cardiac involvement.
- Lyme carditis: Lyme disease can cause cardiac manifestations, including conduction abnormalities like RBBB and hypertension.
- Rare Diagnoses
- Arrhythmogenic right ventricular cardiomyopathy (ARVC): A rare condition that affects the right ventricle and can cause RBBB and other arrhythmias.
- Cardiac tumors (e.g., cardiac fibroma): Rare cardiac tumors can cause conduction abnormalities, including RBBB, by infiltrating or compressing the conduction system.
- Infiltrative diseases (e.g., amyloidosis): These rare conditions can affect the heart and cause both conduction abnormalities and hypertension.