ECG Differential Diagnosis for LEO with Occasional Palpitations
Single Most Likely Diagnosis
- Normal Variant ECG or Sinus Arrhythmia: This is the most likely diagnosis given the patient's occasional palpitations and otherwise unremarkable past medical history (PMH). Many individuals experience occasional palpitations due to benign causes such as anxiety, stress, or normal variations in heart rhythm.
Other Likely Diagnoses
- Supraventricular Tachycardia (SVT): SVT is a common cause of palpitations and can be intermittent, making it a plausible diagnosis in this case. It often presents with sudden onset and termination of palpitations.
- Premature Atrial Contractions (PACs) or Premature Ventricular Contractions (PVCs): These are common benign arrhythmias that can cause palpitations. They are often seen in healthy individuals and may be more noticeable during periods of stress or anxiety.
- Anxiety or Stress-Related Palpitations: Given the patient's role as a Law Enforcement Officer (LEO), stress and anxiety could be contributing factors to their palpitations, even in the absence of a significant cardiac abnormality on the ECG.
Do Not Miss Diagnoses
- Wolff-Parkinson-White (WPW) Syndrome: Although less common, WPW syndrome is a condition that can cause palpitations and has the potential for serious complications, including sudden cardiac death. It is characterized by an accessory electrical pathway in the heart.
- Long QT Syndrome: This is a disorder of the heart's electrical activity that can cause sudden, uncontrollable, dangerous arrhythmias. It may not always be apparent on a standard ECG but is crucial to consider due to its potential for lethal outcomes.
- Hypertrophic Cardiomyopathy (HCM): HCM is a condition where the heart muscle becomes thickened, which can lead to arrhythmias and sudden cardiac death. It might not be directly diagnosed from an ECG but should be considered, especially in individuals with a family history or those engaged in high-stress professions.
Rare Diagnoses
- Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC): A rare heart condition where the muscle in the right ventricle is replaced by fat and scar tissue, potentially leading to life-threatening arrhythmias.
- Brugada Syndrome: A genetic disorder characterized by abnormal ECG findings and an increased risk of sudden cardiac death, often presenting with no prior symptoms.
- Catecholaminergic Polymorphic Ventricular Tachycardia (CPVT): A rare arrhythmia disorder that can cause sudden cardiac death, often triggered by physical activity or emotional stress.