Differential Diagnosis for Exertional Symptoms
The following differential diagnosis is organized into categories to help guide the thought process.
Single most likely diagnosis
- Dehydration: This is often the most common cause of exertional symptoms, especially in individuals who engage in strenuous physical activity without adequate fluid intake. Dehydration can lead to symptoms such as dizziness, fatigue, and muscle cramps.
Other Likely diagnoses
- Heat Exhaustion: This condition occurs when the body loses too much water and salt, usually due to excessive sweating. Symptoms include heavy sweating, pale skin, fast and weak pulse, nausea or vomiting, and dizziness.
- Muscle Strain: Overuse or improper use of muscles can lead to strain, causing pain, stiffness, and limited mobility.
- Asthma: Exertional asthma, also known as exercise-induced bronchospasm (EIB), is a condition in which the airways narrow and constrict in response to exercise, leading to symptoms such as wheezing, coughing, and shortness of breath.
Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Myocardial Infarction (Heart Attack): Although less common in younger individuals, a heart attack can occur during exertion, especially in those with underlying heart disease. Symptoms include chest pain, shortness of breath, and fatigue.
- Cardiac Arrhythmias: Certain arrhythmias, such as long QT syndrome, can be triggered by exertion and may lead to sudden cardiac death if not recognized and treated promptly.
- Heat Stroke: A life-threatening condition that occurs when the body's temperature regulation fails, causing the body temperature to rise rapidly. Symptoms include high body temperature, confusion, slurred speech, and loss of consciousness.
Rare diagnoses
- Rhabdomyolysis: A serious condition in which muscle tissue breaks down, releasing muscle fiber contents into the blood. This can occur due to extreme physical exertion, especially in individuals who are not accustomed to such activity.
- Exertional Rhabdomyolysis: A rare condition that occurs when muscle damage leads to the release of myoglobin into the bloodstream, causing kidney damage.
- Catecholaminergic Polymorphic Ventricular Tachycardia (CPVT): A rare genetic disorder that can cause life-threatening arrhythmias during physical activity or emotional stress.