Differential Diagnosis

The patient's complex presentation requires a thorough consideration of various diagnoses. The following categories organize the potential diagnoses:

• Single Most Likely Diagnosis
  • Myocardial infarction (MI) or acute coronary syndrome: The patient's scheduled stent procedure, recent TIAs, and escalating fatigue suggest a possible cardiac etiology. The new onset of left-sided chest pain, which worsened over time, and the recent medication change to morphine, which can increase cardiac workload, support this diagnosis.
• Other Likely Diagnoses
  • Pulmonary embolism (PE): The patient's history of breathlessness, wheezing, and recent increase in fatigue could be indicative of a PE, especially given the recent medication change and potential for increased venous thromboembolism risk.
  • Liver disease or hepatitis: The significant elevation in liver enzymes (alk phos, ALT, and AST) over a short period suggests liver pathology, which could be related to the patient's medication change, viral hepatitis, or other liver diseases.
  • Gastroesophageal reflux disease (GERD) or peptic ulcer disease: The patient's upper left-sided abdominal pain and recent medication change to morphine, which can increase gastric acid production, could contribute to GERD or peptic ulcer disease.
• Do Not Miss Diagnoses
  • Aortic dissection: Although less likely, the patient's history of hypertension, recent TIAs, and new onset of left-sided chest pain necessitate consideration of aortic dissection, which is a life-threatening condition.
  • Cardiac tamponade: The patient's escalating fatigue, recent TIAs, and scheduled stent procedure increase the risk of cardiac tamponade, which requires prompt recognition and treatment.
  • Pulmonary hypertension: The patient's history of breathlessness, wheezing, and recent increase in fatigue could be indicative of pulmonary hypertension, which would require specific management and treatment.
• Rare Diagnoses
  • Hepatic artery thrombosis: Although rare, the patient's significant elevation in liver enzymes and recent medication change could contribute to hepatic artery thrombosis, especially if the patient has underlying liver disease or other risk factors.
  • Cardiac sarcoidosis: The patient's recent TIAs, escalating fatigue, and left-sided chest pain could be indicative of cardiac sarcoidosis, a rare condition that requires specific diagnosis and treatment.