Differential Diagnosis for a 65 YOF with Syncopal Episodes
Single Most Likely Diagnosis
- Severe Anemia due to Uterine Bleeding: The patient's history of fibroids, severe anemia (HGB of 7.2), and symptoms of syncope and tachycardia (HR of 115) suggest that she may be experiencing significant uterine bleeding, likely due to her fibroids. This is further supported by her elevated platelet count (704), which can occur in response to bleeding.
Other Likely Diagnoses
- Hypertensive Emergency: The patient's blood pressure is significantly elevated (170/86), which could be contributing to her symptoms of syncope. Her history of hypertension also supports this diagnosis.
- Sepsis: The patient's elevated white blood cell count (19.9) with a left shift (16.4 neutrophils) suggests a possible infectious process, which could be contributing to her symptoms of syncope and tachycardia.
- Dehydration: The patient's symptoms of syncope and tachycardia could also be due to dehydration, particularly in the setting of her diabetes mellitus and possible uterine bleeding.
Do Not Miss Diagnoses
- Cardiac Tamponade: Although less likely, cardiac tamponade is a life-threatening condition that can cause syncope and tachycardia. The patient's history of hypertension and possible uterine bleeding increase her risk for this condition.
- Pulmonary Embolism: The patient's symptoms of syncope and tachycardia, combined with her history of fibroids and possible uterine bleeding, increase her risk for pulmonary embolism.
- Aortic Dissection: The patient's significantly elevated blood pressure and symptoms of syncope and tachycardia increase her risk for aortic dissection, a life-threatening condition.
Rare Diagnoses
- Pheochromocytoma: Although rare, pheochromocytoma is a possible cause of the patient's significantly elevated blood pressure and symptoms of syncope and tachycardia.
- Hemorrhagic Stroke: The patient's significantly elevated blood pressure and symptoms of syncope increase her risk for hemorrhagic stroke, although this is a less likely diagnosis given her presentation.