Differential Diagnosis
The patient presents with palpitations, hay fever symptoms, and concern about having a heart attack. The following differential diagnoses are considered:
- Single most likely diagnosis
- Anxiety Disorder: The patient's symptoms of palpitations, chest discomfort, and difficulty breathing are exacerbated by lying down and smoking, which can be triggers for anxiety. The GAD-7 score of 19 indicates severe anxiety, supporting this diagnosis.
- Other Likely diagnoses
- Asthma Exacerbation: Although the patient reports not using their inhaler much lately, the symptoms of chest discomfort and difficulty breathing could be related to asthma, especially given the patient's history of asthma.
- Allergic Rhinitis: The patient's symptoms of runny nose, blocked nose, and swollen tongue sensation are consistent with allergic rhinitis, which is likely contributing to their discomfort.
- Smoking-Related Cardiovascular Disease: The patient's smoking history and symptoms of palpitations and chest discomfort raise concern for smoking-related cardiovascular disease, such as coronary artery disease or cardiac arrhythmias.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Myocardial Infarction: Although the patient's ECG shows sinus bradycardia, it is essential to consider myocardial infarction as a potential cause of their symptoms, especially given their concern about having a heart attack.
- Pulmonary Embolism: The patient's symptoms of difficulty breathing and chest discomfort could be indicative of a pulmonary embolism, which would require immediate attention.
- Cardiac Arrhythmia: The patient's ECG shows tall T waves in chest leads V3-V6, which could be indicative of a cardiac arrhythmia, such as hyperkalemia or long QT syndrome.
- Rare diagnoses
- Pheochromocytoma: The patient's symptoms of palpitations, chest discomfort, and hypertension could be related to a pheochromocytoma, although this is a rare condition.
- Cardiac Sarcoidosis: The patient's symptoms of palpitations and chest discomfort, combined with their asthma history, could be related to cardiac sarcoidosis, although this is a rare condition.