Differential Diagnosis for Palpitations

The following is a differential diagnosis for palpitations, categorized for clarity and emphasis on potential severity.

• Single Most Likely Diagnosis
  • Anxiety or Stress: Often the most common cause of palpitations, anxiety and stress can lead to an awareness of one's heartbeat, making it feel irregular or forceful.
• Other Likely Diagnoses
  • Premature Atrial Contractions (PACs) or Premature Ventricular Contractions (PVCs): These are common and usually benign heart rhythms that can cause the sensation of skipped beats or palpitations.
  • Sinus Tachycardia: An increased heart rate that can be caused by a variety of factors including exercise, fever, dehydration, or stimulant use.
  • Mitral Valve Prolapse: A condition where the two valve flaps of the mitral valve do not close smoothly or evenly, which can cause palpitations among other symptoms.
• Do Not Miss Diagnoses
  • Atrial Fibrillation: A type of irregular heartbeat that can increase the risk of stroke, heart failure, and other heart-related complications.
  • Ventricular Tachycardia: A potentially life-threatening arrhythmia that can lead to ventricular fibrillation and cardiac arrest if not treated promptly.
  • Cardiac Tamponade: Fluid accumulation in the sac around the heart (pericardium) that can compress the heart and impede its function, leading to palpitations among other severe symptoms.
  • Hypertrophic Cardiomyopathy: A condition where the heart muscle becomes abnormally thick, which can lead to obstructive and arrhythmic complications.
• Rare Diagnoses
  • Thyroid Storm: A life-threatening complication of untreated or undertreated hyperthyroidism that can cause severe palpitations among other symptoms.
  • Pheochromocytoma: A rare tumor of the adrenal gland that can cause episodes of palpitations, hypertension, and other symptoms due to excessive catecholamine release.
  • 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.

Each of these diagnoses has a unique set of causes, symptoms, and implications for patient care, emphasizing the importance of a thorough evaluation to determine the underlying cause of palpitations.