Differential Diagnosis for Heart Palpitations

The differential diagnosis for heart palpitations is broad and can be categorized based on the likelihood and potential impact of missing a diagnosis.

• Single Most Likely Diagnosis
  • Anxiety or Stress: Often, heart palpitations are associated with anxiety or stress, which can cause an increase in heart rate and the sensation of palpitations. This is a common and relatively benign condition but can be distressing for the patient.
• Other Likely Diagnoses
  • Premature Atrial Contractions (PACs) or Premature Ventricular Contractions (PVCs): These are common arrhythmias that can cause the sensation of skipped beats or palpitations. They are often benign but can be a source of concern for patients.
  • Sinus Tachycardia: An increased heart rate can be perceived as palpitations. This can be due to a variety of causes including dehydration, fever, or stimulant use.
  • Mitral Valve Prolapse: A condition where the mitral valve does not close properly, which can lead to palpitations among other symptoms.
• Do Not Miss Diagnoses
  • Myocardial Infarction (MI) or Acute Coronary Syndrome: Although less common, palpitations can be a symptom of an MI, especially in patients with risk factors. Missing this diagnosis can be fatal.
  • Atrial Fibrillation: A type of irregular heartbeat that can lead to palpitations. It increases the risk of stroke, heart failure, and other heart-related complications.
  • Ventricular Tachycardia: A potentially life-threatening arrhythmia that requires immediate medical attention.
  • Cardiac Tamponade: Fluid accumulation in the pericardial sac that can compress the heart and lead to palpitations, among other severe symptoms.
• Rare Diagnoses
  • Hypertrophic Cardiomyopathy: A condition where the heart muscle becomes thickened, which can lead to palpitations and is a common cause of sudden cardiac death in young athletes.
  • Long QT Syndrome: A disorder of the heart's electrical activity that can cause sudden, uncontrollable, dangerous arrhythmias.
  • Pheochromocytoma: A rare tumor of the adrenal gland that can cause episodes of palpitations, hypertension, and other symptoms due to excessive catecholamine release.
  • Thyroid Storm: A life-threatening condition that represents an extreme exacerbation of thyrotoxicosis, which can cause palpitations among other severe symptoms.

Each of these diagnoses has a different set of implications for patient management and outcome, emphasizing the importance of a thorough evaluation to determine the underlying cause of heart palpitations.