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Differential Diagnosis for 50-year-old Patient with Cardiac Symptoms

Single Most Likely Diagnosis

  • Anxiety or Stress-related Symptoms: The patient's symptoms occur with sinus rhythm, and the Holter monitor shows sinus tachycardia, which can be associated with anxiety or stress. The presence of rare PACs (premature atrial contractions) and PVCs (premature ventricular contractions) can also be benign and related to stress or anxiety.

Other Likely Diagnoses

  • Mitral Valve Prolapse: Although the echo is negative, some cases of mitral valve prolapse might not be detected on a standard echocardiogram, especially if the prolapse is mild or if the echo was not performed during a time when the patient was experiencing symptoms.
  • Cardiac Syndrome X: This condition is characterized by chest pain with normal coronary arteries. The patient's symptoms and normal CTA heart and coronary arteries make this a possible diagnosis.
  • Hyperventilation Syndrome: This can cause symptoms similar to cardiac issues, including palpitations and shortness of breath, and can be associated with sinus tachycardia.

Do Not Miss Diagnoses

  • Cardiac Sarcoidosis: Although rare, cardiac sarcoidosis can cause a variety of arrhythmias, including ventricular couplets, and can be missed if not specifically looked for. It's crucial to consider this diagnosis due to its potential severity.
  • Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC): This condition can cause ventricular arrhythmias, including couplets, and can be associated with sudden cardiac death. A normal echo does not rule out ARVC, as the right ventricle can be difficult to assess.
  • Myocardial Bridging: This is a condition where a portion of a coronary artery dives into and is surrounded by the myocardium. It can cause ischemia and arrhythmias, even with a normal coronary CTA.

Rare Diagnoses

  • Infiltrative Cardiomyopathies (e.g., Amyloidosis): These conditions can cause arrhythmias and can have a normal echo and coronary CTA. However, they are rare and typically present with other systemic symptoms.
  • Catecholaminergic Polymorphic Ventricular Tachycardia (CPVT): This is a rare genetic disorder that can cause ventricular arrhythmias, including couplets, typically during physical activity or emotional stress. It's an important consideration in patients with unexplained ventricular arrhythmias.

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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