Differential Diagnosis for Atrial Fibrillation

The patient presents with symptoms of palpitations and shortness of breath, and an electrocardiogram (ECG) confirms atrial fibrillation (AF) with rapid ventricular response. Given her symptoms started about 1 week ago, with episodes being intermittent and terminating within a few hours, we can categorize the differential diagnosis as follows:

• Single Most Likely Diagnosis
  • Paroxysmal Atrial Fibrillation: This is the most likely diagnosis because the patient's AF episodes are intermittent, lasting less than 7 days, and terminate spontaneously. The fact that her symptoms and AF episodes resolve within a few hours and she had a normal sinus rhythm on a previous ECG supports this diagnosis.
• Other Likely Diagnoses
  • Persistent Atrial Fibrillation: Although less likely given the intermittent nature of her symptoms, persistent AF is a possibility if the episodes were to last longer than 7 days or if the patient's condition were to progress. However, the current description of her condition does not fully align with persistent AF, which typically requires cardioversion or other interventions to restore sinus rhythm.
• Do Not Miss Diagnoses
  • Permanent Atrial Fibrillation: While not likely given the patient's recent onset and intermittent symptoms, permanent AF (where the decision has been made not to pursue restoration of sinus rhythm) is a consideration in the management of AF. However, this diagnosis would be premature without further evaluation and discussion of treatment goals.
  • Underlying Conditions Leading to Atrial Fibrillation: It's crucial not to miss underlying conditions that could be causing or contributing to AF, such as thyroid disease, cardiac valve problems, or pulmonary embolism. These conditions could significantly alter the management approach.
• Rare Diagnoses
  • Long-Standing Persistent Atrial Fibrillation: This diagnosis refers to AF that has been present for more than a year. Given the patient's recent onset of symptoms and previous documentation of sinus rhythm, this is less likely but could be considered if the patient's condition evolves over time.
  • Other Rare Causes of Atrial Fibrillation: Such as cardiac tumors, infiltrative heart diseases, or genetic conditions that predispose to AF. These are less common and would typically require specific diagnostic testing to identify.

Each diagnosis is considered based on the duration of atrial fibrillation episodes, the patient's symptoms, and the presence of underlying conditions that could influence the diagnosis and management of AF.