Differential Diagnosis for 91-year-old Female with COPD, Unresolved Cough, and SOB
Single Most Likely Diagnosis
- Congestive Heart Failure (CHF): The patient's symptoms of unresolved cough and shortness of breath (SOB), combined with the echocardiogram findings of mildly reduced left ventricular systolic function, enlarged left atrial chamber dimension, and mild pulmonary hypertension, are consistent with CHF. The presence of a mitral valve replacement and the patient's age also support this diagnosis.
Other Likely Diagnoses
- Cor Pulmonale: The patient's history of COPD, enlarged right ventricular chamber dimension, and mild pulmonary hypertension suggest cor pulmonale, which is right-sided heart failure caused by lung disease.
- Volume Overload: The patient is taking Lasix, a diuretic, which suggests that she may be experiencing volume overload. The enlarged inferior vena cava and elevated right atrial pressure also support this diagnosis.
- Tricuspid Regurgitation: The mild tricuspid valve regurgitation noted on the echocardiogram could be contributing to the patient's symptoms and elevated right atrial pressure.
Do Not Miss Diagnoses
- Pulmonary Embolism (PE): Although the patient has mild pulmonary hypertension, a PE could be causing or contributing to her symptoms. A PE would be a life-threatening condition that requires immediate attention.
- Cardiac Tamponade: Although the echocardiogram shows no pericardial effusion, cardiac tamponade is a life-threatening condition that can cause similar symptoms. It is essential to consider this diagnosis, especially if the patient's condition worsens.
- Mitral Valve Prosthesis Dysfunction: The patient has a mitral valve replacement, and although the echocardiogram shows that it is well-seated, prosthesis dysfunction could be causing or contributing to her symptoms.
Rare Diagnoses
- Constrictive Pericarditis: This is a rare condition where the pericardium becomes scarred and contracts, restricting the heart's ability to fill. Although the echocardiogram shows no pericardial effusion, constrictive pericarditis could be considered if other diagnoses are ruled out.
- Restrictive Cardiomyopathy: This is a rare condition where the heart muscle becomes stiff, restricting the heart's ability to fill. Although the echocardiogram shows mildly reduced left ventricular systolic function, restrictive cardiomyopathy could be considered if other diagnoses are ruled out.