Differential Diagnosis
The patient's symptoms of tiredness, lethargy, heart palpitations, chest pain, and shortness of breath, along with near-syncopal episodes, suggest a range of potential diagnoses. Here's a categorized differential diagnosis:
Single Most Likely Diagnosis
- Anxiety Disorder: The patient's symptoms of heart palpitations, chest pain, shortness of breath, and feeling like she's going to pass out, especially when triggered by specific movements like bending over or turning her head, could be indicative of a panic disorder or anxiety attack. The description of her heart feeling like it's trying to beat out of her chest and being squeezed is consistent with the somatic symptoms often reported in anxiety disorders.
Other Likely Diagnoses
- Hypothyroidism: This condition can cause fatigue, lethargy, and shortness of breath. While less directly linked to palpitations and chest pain triggered by movement, hypothyroidism can lead to cardiovascular symptoms due to its effects on the heart and metabolic rate.
- Mitral Valve Prolapse: A condition where the two valve flaps of the mitral valve do not close smoothly or evenly but instead bulge (prolapse) upward into the left atrium when the heart contracts. It can cause palpitations, chest pain, and shortness of breath, especially when bending over or changing positions.
- Asthma or Chronic Obstructive Pulmonary Disease (COPD): Both conditions can cause shortness of breath and, in severe cases, palpitations due to hypoxia. However, they are less likely to cause the specific pattern of chest pain and palpitations described.
Do Not Miss Diagnoses
- Cardiac Arrhythmias (e.g., Supraventricular Tachycardia, Atrial Fibrillation): These conditions can cause palpitations, shortness of breath, and chest discomfort. They are critical to diagnose due to the potential for serious complications if left untreated.
- Pulmonary Embolism: Although less likely given the description, pulmonary embolism can cause sudden onset of shortness of breath, chest pain, and palpitations. It's a life-threatening condition that requires immediate diagnosis and treatment.
- Cardiac Tamponade: A condition where fluid accumulates in the sac around the heart, leading to impaired heart function. It can cause chest pain, shortness of breath, and palpitations, and is a medical emergency.
Rare Diagnoses
- Pheochromocytoma: A rare tumor of the adrenal gland that can cause episodes of palpitations, sweating, headache, and chest pain due to sudden releases of catecholamines.
- Hyperthyroidism: Although more commonly associated with weight loss and increased energy, in some cases, it can cause fatigue, palpitations, and shortness of breath, especially in older adults or those with pre-existing heart conditions.
- Pericarditis: Inflammation of the pericardium, the sac surrounding the heart, which can cause chest pain that may improve with sitting up and leaning forward, and can be associated with palpitations and shortness of breath in severe cases.