Differential Diagnosis
The patient's symptoms of a racing heart and fear of not waking up, along with her emotional distress and previous ER visits, suggest a complex clinical picture. Here's a categorized differential diagnosis:
- Single Most Likely Diagnosis
- Anxiety Disorder: The patient's symptoms of a racing heart, fear of not waking up, and emotional distress are classic for an anxiety disorder, particularly panic disorder. The fact that she has been to the ER multiple times with similar complaints and has been told that everything is normal suggests that her symptoms may be more related to anxiety than an underlying cardiac issue.
- Other Likely Diagnoses
- Hypothyroidism: This condition can cause cardiac symptoms such as palpitations and tachycardia, as well as anxiety and emotional distress.
- Anemia: The patient's chronically elevated white count could be a sign of an underlying infection or inflammation, which could be contributing to her symptoms. Anemia could also cause palpitations and shortness of breath.
- Cardiac Arrhythmia: Although the patient's monitor results were normal, it's possible that she is experiencing intermittent arrhythmias that are not being captured.
- Do Not Miss Diagnoses
- Cardiac Tamponade: This is a life-threatening condition where fluid accumulates in the sac around the heart, causing cardiac compression. Although unlikely, it could cause palpitations and shortness of breath.
- Pulmonary Embolism: This is another life-threatening condition that could cause cardiac symptoms, including palpitations and shortness of breath.
- Hyperthyroidism: This condition can cause cardiac symptoms such as palpitations and tachycardia, as well as anxiety and emotional distress.
- Rare Diagnoses
- Pheochromocytoma: This is a rare tumor of the adrenal gland that can cause episodic palpitations, tachycardia, and hypertension.
- Postural Orthostatic Tachycardia Syndrome (POTS): This is a rare condition characterized by a rapid heart rate and other symptoms that occur upon standing.