Differential Diagnosis for Palpitations

The patient's symptoms of palpitations, chest tightness, lightheadedness, and anxiety, which resolved spontaneously, suggest a range of possible diagnoses. Here's a categorized differential diagnosis:

• Single Most Likely Diagnosis

  • Panic Attack: The symptoms of palpitations, chest tightness, lightheadedness, and anxiety are classic for a panic attack, especially given the sudden onset and resolution. A GAD-7 score of 6 would support this diagnosis, indicating mild anxiety, which is consistent with panic disorder.

• Other Likely Diagnoses

  • Mitral Valve Prolapse: This condition can cause palpitations, chest discomfort, and anxiety symptoms, especially if there is associated mitral regurgitation. Mitral valve prolapse seen on an echocardiogram would confirm this diagnosis.
  • Thyroid Dysfunction: Hyperthyroidism can cause palpitations, anxiety, and chest tightness. An elevated TSH level might indicate hypothyroidism, but thyroid dysfunction in either direction can lead to cardiac symptoms.
  • Supraventricular Tachycardia (SVT): Characterized by a sudden onset of rapid heart rate, which can be associated with palpitations, chest tightness, and anxiety. P waves hidden within a narrow QRS complex on EKG could indicate SVT.

• Do Not Miss Diagnoses

  • Cardiac Ischemia: Although less likely in a young female without risk factors, cardiac ischemia can present with atypical symptoms including palpitations and anxiety. Atherosclerotic plaque seen on carotid ultrasonography might suggest atherosclerotic disease, but this finding would be unusual and not directly diagnostic of cardiac ischemia in this context.
  • Arrhythmias: Various arrhythmias, including atrial fibrillation or ventricular tachycardia, can present with palpitations and require immediate attention. These conditions might not have been captured on a single EKG but warrant consideration.

• Rare Diagnoses

  • Pheochromocytoma: A rare tumor of the adrenal gland that can cause episodic palpitations, hypertension, and anxiety due to catecholamine release.
  • Hypertrophic Cardiomyopathy: A condition that can lead to obstructive cardiomyopathy and cause symptoms during exertion or stress, including palpitations and chest tightness.
  • Long QT Syndrome: A disorder of the heart's electrical activity that can cause sudden, uncontrollable, dangerous arrhythmias, often triggered by stress or exertion.

Each of these diagnoses has a different set of implications for management and prognosis, highlighting the importance of a thorough evaluation to determine the underlying cause of the patient's symptoms.