Differential Diagnosis for Heart Palpitations

The following is a differential diagnosis for heart palpitations, categorized for clarity and emphasis on critical conditions.

• Single Most Likely Diagnosis

  • Anxiety or Stress: Heart palpitations are a common symptom of anxiety and stress, often accompanied by other symptoms such as shortness of breath, tremors, and chest discomfort. The high prevalence of anxiety disorders and the frequent occurrence of stress in daily life make this a common cause.

• Other Likely Diagnoses

  • Atrial Fibrillation: A common arrhythmia characterized by rapid and irregular heart rhythms. It's more common in older adults and those with heart disease.
  • Premature Atrial Contractions (PACs) or Premature Ventricular Contractions (PVCs): These are extra beats that can feel like palpitations. They are very common and often benign but can be concerning to patients.
  • 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 among other symptoms.
  • Hypothyroidism or Hyperthyroidism: Thyroid disorders can affect heart rate, leading to palpitations. Hypothyroidism is more common, but hyperthyroidism is more likely to cause palpitations.

• Do Not Miss Diagnoses

  • Myocardial Infarction (MI) or Acute Coronary Syndrome: Although less common, palpitations can be a symptom of a heart attack, especially in women or individuals with atypical presentations.
  • Pulmonary Embolism: A blockage of an artery in the lungs that can cause sudden onset of palpitations among other severe symptoms.
  • Cardiac Tamponade: Fluid accumulation in the sac around the heart (pericardium) that can compress the heart and impede its function, leading to palpitations and potentially fatal outcomes if not promptly treated.
  • Hypertrophic Cardiomyopathy: A condition where the heart muscle becomes thick, which can lead to obstructed blood flow and increase the risk of sudden cardiac death, especially in young athletes.

• 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.
  • Long QT Syndrome: A disorder of the heart's electrical activity that can cause sudden, uncontrollable, dangerous arrhythmias.
  • Brugada Syndrome: A genetic disorder characterized by abnormal electrocardiogram (ECG) findings and an increased risk of sudden cardiac death.
  • Pheochromocytoma: A rare tumor of the adrenal gland that can cause episodes of palpitations, hypertension, and other symptoms due to excessive catecholamine release.

Each of these diagnoses has distinct implications for patient management and outcome, emphasizing the importance of a thorough diagnostic evaluation for heart palpitations.