Differential Diagnosis
- Single most likely diagnosis
- Atrial fibrillation with probable anterolateral infarct: The EKG shows atrial fibrillation and probable anterolateral infarct, which suggests that the patient is experiencing a myocardial infarction (heart attack) due to a blockage in the coronary arteries. The atrial fibrillation increases the risk of thromboembolic events, which could lead to a stroke, but the CT head is negative for ischemic or acute findings.
- Other Likely diagnoses
- Cardiac arrhythmia: The presence of pacemaker spikes or artifacts on the EKG suggests that the patient has a pacemaker, which could be causing or contributing to the atrial fibrillation.
- Pulmonary embolism: Although the D-dimer is only slightly elevated (0.27), it is still possible that the patient has a pulmonary embolism, especially if they have risk factors such as immobility, cancer, or recent surgery.
- Cardiomyopathy: The patient's age is indeterminate, but if they are older, they may be at risk for cardiomyopathy, which could be contributing to the atrial fibrillation and probable anterolateral infarct.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Aortic dissection: Although the CT head is negative, it is still possible that the patient has an aortic dissection, which could be causing the atrial fibrillation and probable anterolateral infarct. Aortic dissection is a life-threatening condition that requires immediate attention.
- Cardiac tamponade: The patient's symptoms and EKG findings could also be consistent with cardiac tamponade, which is a life-threatening condition that requires immediate attention.
- Stroke: Although the CT head is negative, it is still possible that the patient has had a stroke, especially if they have atrial fibrillation, which increases the risk of thromboembolic events.
- Rare diagnoses
- Arrhythmogenic right ventricular cardiomyopathy (ARVC): This is a rare condition that affects the right ventricle and can cause arrhythmias, including atrial fibrillation.
- Brugada syndrome: This is a rare genetic disorder that affects the heart's electrical system and can cause arrhythmias, including atrial fibrillation.
- Cardiac sarcoidosis: This is a rare condition that affects the heart and can cause arrhythmias, including atrial fibrillation.