Differential Diagnosis for a 65 YOF with Syncopal Episodes
Single Most Likely Diagnosis
- Uterine bleeding due to fibroids: The patient's history of fibroids, severe anemia (HGB of 7.2), and recent syncopal episodes suggest that uterine bleeding is the most likely cause of her symptoms. The low hemoglobin level and high heart rate (115) are consistent with significant blood loss.
Other Likely Diagnoses
- Hypertensive emergency: The patient's high blood pressure (170/86) and history of hypertension could be contributing to her symptoms, particularly if she has underlying cardiovascular disease. However, the severe anemia is a more likely cause of her syncopal episodes.
- Sepsis: The patient's elevated white blood cell count (19.9) and neutrophilia (16.4) could indicate an underlying infection. However, her temperature is only slightly elevated (98.8), and there is no clear source of infection mentioned.
- Dehydration: The patient's tachycardia and hypertension could be signs of dehydration, particularly in the context of her diabetes and potential blood loss.
Do Not Miss Diagnoses
- Cardiac arrhythmia or myocardial infarction: Although less likely, a cardiac cause of the patient's syncopal episodes could be deadly if missed. Her age, hypertension, and diabetes put her at risk for cardiovascular disease.
- Pulmonary embolism: A pulmonary embolism could cause syncopal episodes and is a potentially life-threatening condition. Although less likely, it should be considered in the differential diagnosis.
- Intra-abdominal bleeding: Although the patient's history of fibroids suggests uterine bleeding, intra-abdominal bleeding from another source (e.g., a ruptured aneurysm) could also cause her symptoms.
Rare Diagnoses
- Pheochromocytoma: This rare tumor could cause episodic hypertension and tachycardia, leading to syncopal episodes. However, it is unlikely given the patient's other symptoms and laboratory results.
- Hemorrhagic stroke: A hemorrhagic stroke could cause sudden onset of symptoms, including syncope. However, the patient's symptoms and laboratory results do not strongly suggest this diagnosis.
- Thyroid storm: The patient's tachycardia and hypertension could be signs of a thyroid storm, particularly in the context of her diabetes. However, there is no other evidence to support this diagnosis.