Differential Diagnosis for Arrhythmia
The following differential diagnosis is organized into categories to help guide the thought process and ensure that potentially life-threatening conditions are not missed.
Single Most Likely Diagnosis
- Atrial Fibrillation: This is one of the most common arrhythmias, particularly in older adults, and can be caused by a variety of factors including hypertension, heart disease, and thyroid disorders. Its prevalence and the broad range of symptoms it can present make it a likely initial consideration.
Other Likely Diagnoses
- Supraventricular Tachycardia (SVT): This includes conditions like atrioventricular nodal reentrant tachycardia (AVNRT) and atrioventricular reentrant tachycardia (AVRT), which are common and can present with palpitations, shortness of breath, and sometimes chest pain.
- Ventricular Tachycardia (VT): Although less common than SVT, VT is a significant consideration, especially in patients with known heart disease, as it can lead to severe consequences if not promptly treated.
- Sinus Tachycardia: Often a response to stress, dehydration, or other non-cardiac conditions, sinus tachycardia is common and usually benign but can be a symptom of an underlying issue that needs addressing.
Do Not Miss Diagnoses
- Cardiac Tamponade: Although rare, cardiac tamponade can present with arrhythmias among other symptoms and is life-threatening if not promptly diagnosed and treated.
- Pulmonary Embolism: Can cause arrhythmias, particularly sinus tachycardia, and is a medical emergency that requires immediate attention.
- Myocardial Infarction: Arrhythmias can be a presenting feature of a heart attack, and missing this diagnosis can have fatal consequences.
- Hyperkalemia/Hypokalemia: Electrolyte imbalances can cause various arrhythmias and are critical to identify and treat to prevent serious complications.
Rare Diagnoses
- Brugada Syndrome: A genetic disorder that can lead to life-threatening arrhythmias, particularly VT, and often presents with a characteristic ECG pattern.
- Long QT Syndrome: Another genetic condition that can cause VT and torsades de pointes, often triggered by certain medications or stress.
- Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC): A rare heart condition that can lead to VT and sudden cardiac death, often in young individuals and athletes.
- Wolff-Parkinson-White (WPW) Syndrome: A condition characterized by an accessory electrical pathway in the heart, leading to SVT, which can be life-threatening if not properly managed.