Differential Diagnosis for Elevated Resting Pulse and Variability
The patient presents with an elevated resting pulse of 85 bpm, which can increase to 100-150 bpm with brief runs, a sedentary lifestyle, significant weight gain, sleep apnea, and a history of COVID-19 in 2020. Considering these factors, the differential diagnosis can be categorized as follows:
- Single Most Likely Diagnosis
- Deconditioning: Given the patient's sedentary lifestyle and significant weight gain of 45 pounds, deconditioning is the most likely cause of the elevated resting pulse and variability. This is exacerbated by the cessation of regular weightlifting, leading to a decrease in cardiovascular fitness.
- Other Likely Diagnoses
- Sleep Apnea: Although the patient is already diagnosed with sleep apnea, it is essential to consider its impact on cardiovascular health. Untreated or poorly managed sleep apnea can contribute to elevated pulse rates and variability.
- Hypertension: Despite an average blood pressure of 115/76, which is within a relatively normal range, the patient's weight gain and sedentary lifestyle may indicate a risk of developing hypertension, contributing to the elevated pulse.
- Post-COVID-19 Cardiovascular Effects: COVID-19 has been associated with various cardiovascular complications, including myocarditis, pericarditis, and arrhythmias. Although it has been four years since the patient's COVID-19 infection, some lingering cardiovascular effects could contribute to the elevated pulse.
- Do Not Miss Diagnoses
- Cardiac Arrhythmias: Conditions like atrial fibrillation or supraventricular tachycardia can cause significant variability in heart rate and should not be missed due to their potential for serious complications.
- Thyroid Dysfunction: Both hyperthyroidism and hypothyroidism can affect heart rate, and given the patient's significant weight gain, thyroid function should be evaluated to rule out any underlying thyroid issues.
- Anemia: Although less likely, anemia can cause an elevated heart rate and should be considered, especially if there are other symptoms such as fatigue or shortness of breath.
- Rare Diagnoses
- Pheochromocytoma: A rare tumor of the adrenal gland that can cause episodes of high blood pressure and heart rate variability.
- Cardiac Sarcoidosis: A condition where granulomas form in the heart, potentially leading to arrhythmias and other cardiac issues.
Given the patient's history and current health status, consulting a DC DABCI (Diplomate of the American Board of Chiropractic Internists) could be beneficial, as they can provide guidance on lifestyle modifications, nutrition, and potentially refer the patient to other specialists if necessary. However, it is also crucial to consider consulting a cardiologist to rule out any underlying cardiac conditions that may require immediate attention.