Differential Diagnosis

The patient presents with a complex array of symptoms including heart palpitations, hay fever symptoms, severe anxiety, tremors, and respiratory issues. The following differential diagnoses are considered based on the provided information:

• Single Most Likely Diagnosis
  • Generalized Anxiety Disorder (GAD): The patient's severe anxiety symptoms (GAD-7 score of 19), constant worrying, restlessness, irritability, and fear of having a heart attack are highly suggestive of GAD. The presence of palpitations, tremors, and respiratory symptoms can also be associated with anxiety disorders.
• Other Likely Diagnoses
  • Asthma Exacerbation: Given the patient's history of asthma and current symptoms of difficulty breathing and feeling pressed, an asthma exacerbation is a possible diagnosis. However, the absence of wheeze on examination and good air entry in all areas makes this less likely.
  • Allergic Rhinitis: The patient's symptoms of runny nose and nasal blockage are consistent with allergic rhinitis, especially given the history of hay fever.
  • Nicotine Dependence: The patient's long history of smoking and current daily smoking habit suggest nicotine dependence, which can contribute to anxiety, palpitations, and respiratory symptoms.
• Do Not Miss Diagnoses
  • Cardiac Arrhythmia or Ischemia: Although the patient's ECG is pending, it's crucial to rule out cardiac pathology given the symptoms of palpitations, chest pain, and concern about having a heart attack. Conditions like atrial fibrillation, supraventricular tachycardia, or myocardial ischemia need to be considered.
  • Thyroid Disorder: The patient's symptoms of tremors, palpitations, and anxiety could be indicative of a thyroid disorder, such as hyperthyroidism. Although less likely, this diagnosis should not be missed due to its significant impact on the patient's health.
• Rare Diagnoses
  • Pheochromocytoma: This rare tumor of the adrenal gland can cause episodic palpitations, tremors, and anxiety. Although unlikely, it's a diagnosis that should be considered in the differential due to its potential severity.
  • Carcinoid Syndrome: Given the patient's symptoms of flushing (not explicitly mentioned but could be related to the swollen tongue), diarrhea (not mentioned), wheezing, and heart palpitations, carcinoid syndrome is a rare but possible diagnosis. However, this would be extremely unlikely without other supporting symptoms or findings.