Palpitation Differential Diagnosis

The differential diagnosis for palpitations can be organized into the following categories:

• Single Most Likely Diagnosis
  • Anxiety or Stress: This is often the most common cause of palpitations, as stress and anxiety can stimulate the heart and lead to an awareness of its beating.
• Other Likely Diagnoses
  • Atrial Fibrillation: A common arrhythmia that can cause palpitations due to irregular heartbeats.
  • Premature Atrial Contractions (PACs) or Premature Ventricular Contractions (PVCs): These are extra beats that can cause a sensation of palpitations.
  • Mitral Valve Prolapse: A condition where the mitral valve does not close properly, which can lead to palpitations.
  • Hypothyroidism or Hyperthyroidism: Thyroid disorders can affect the heart rate and rhythm, leading to palpitations.
  • Dehydration or Electrolyte Imbalance: Dehydration or imbalances in electrolytes like potassium or magnesium can cause palpitations.
• Do Not Miss Diagnoses
  • Ventricular Tachycardia: A potentially life-threatening arrhythmia that requires immediate medical attention.
  • Cardiac Tamponade: Fluid accumulation in the sac around the heart can compress the heart and lead to palpitations, among other serious symptoms.
  • Pulmonary Embolism: A blood clot in the lungs can cause palpitations, along with other symptoms like shortness of breath and chest pain.
  • Hypertrophic Cardiomyopathy: A condition where the heart muscle becomes thickened, which can lead to palpitations and is a significant cause of sudden cardiac death in young athletes.
• Rare Diagnoses
  • Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC): A rare heart condition that can cause palpitations and is associated with sudden cardiac death.
  • Long QT Syndrome: A genetic disorder that affects the heart's electrical system and can cause palpitations and potentially life-threatening arrhythmias.
  • Brugada Syndrome: A genetic disorder that affects the heart's electrical system and can cause palpitations and increase the risk of sudden cardiac death.

Each of these diagnoses has a unique set of characteristics and risk factors. A thorough medical history, physical examination, and diagnostic tests such as ECG, echocardiogram, and blood tests are essential for determining the underlying cause of palpitations.