What is the diagnosis for a patient with EKG readings showing pacemaker spikes, atrial fibrillation, probable anterolateral infarct, abnormal T waves indicating possible ischemia, and artifacts in leads II, aVR, aVL, and aVF, who is hemodynamically stable with anemia (low red blood cell count of 3.61, low hemoglobin of 10.6, and low hematocrit of 32.6), and impaired renal function (elevated creatinine of 1.03 and decreased eGFR of 57)?

Differential Diagnosis

• Single Most Likely Diagnosis
  • Atrial fibrillation with underlying cardiac disease: The EKG reading of atrial fibrillation and probable anterolateral infarct suggests that the patient has a cardiac condition that is causing the arrhythmia and potential ischemia. The presence of pacemaker spikes or artifacts also indicates that the patient has a pre-existing cardiac condition that requires pacing.
• Other Likely Diagnoses
  • Ischemic heart disease: The abnormal T waves in the lateral leads and the probable anterolateral infarct suggest that the patient may have ischemic heart disease, which could be causing the atrial fibrillation and other EKG abnormalities.
  • Anemia: The patient's low hemoglobin (10.6) and hematocrit (32.6) levels suggest that they may have anemia, which could be contributing to their cardiac symptoms and EKG abnormalities.
  • Chronic kidney disease: The patient's elevated creatinine (1.03) and decreased eGFR (57) suggest that they may have chronic kidney disease, which could be contributing to their cardiac symptoms and EKG abnormalities.
• Do Not Miss Diagnoses
  • Cardiac tamponade: Although the patient is stable, cardiac tamponade is a life-threatening condition that can cause EKG abnormalities and should be considered in the differential diagnosis.
  • Pulmonary embolism: The patient's atrial fibrillation and underlying cardiac disease increase their risk for pulmonary embolism, which is a life-threatening condition that requires prompt diagnosis and treatment.
  • Sepsis: The patient's low hemoglobin and hematocrit levels, as well as their elevated creatinine, suggest that they may be at risk for sepsis, which is a life-threatening condition that requires prompt diagnosis and treatment.
• Rare Diagnoses
  • Cardiac sarcoidosis: This is a rare condition that can cause EKG abnormalities, including atrial fibrillation and abnormal T waves.
  • Amyloidosis: This is a rare condition that can cause EKG abnormalities, including atrial fibrillation and abnormal T waves.
  • Hemochromatosis: This is a rare genetic disorder that can cause cardiac symptoms and EKG abnormalities, including atrial fibrillation and abnormal T waves.