Differential Diagnosis for 19 y/o Female with P-Wave Morphology Changes on Holter

• Single Most Likely Diagnosis
  • Supraventricular Tachycardia (SVT): This is a common condition in young adults, characterized by episodes of rapid heart rate originating from above the ventricles. The change in P-wave morphology can indicate a shift in the origin of the heartbeat, consistent with SVT.
• Other Likely Diagnoses
  • Atrial Flutter: This condition involves a rapid but regular atrial rhythm, which can cause changes in P-wave morphology on an ECG. It's less common than SVT but still a plausible explanation for the symptoms.
  • Atrial Fibrillation: Although less likely in a young adult without underlying heart disease, atrial fibrillation can cause irregular P-wave morphology due to the quivering of the atria rather than a coordinated contraction.
• Do Not Miss Diagnoses
  • Wolff-Parkinson-White (WPW) Syndrome: A condition where an accessory electrical pathway between the atria and ventricles causes the heart to beat too quickly. It can lead to life-threatening arrhythmias if not identified and treated.
  • Paroxysmal Atrial Tachycardia with Block: This rare condition involves episodes of rapid atrial rate with variable block, leading to irregular ventricular response, which could be mistaken for other arrhythmias.
• Rare Diagnoses
  • Junctional Tachycardia: Originating from the AV junction, this tachycardia can sometimes present with P-wave morphology changes, although it's less common.
  • Multifocal Atrial Tachycardia: Characterized by multiple P-wave morphologies due to multiple ectopic foci in the atria, this condition is rare and usually associated with underlying pulmonary disease.