What is the diagnosis for a patient with EKG readings showing pacemaker spikes or artifacts, atrial fibrillation, and probable anterolateral infarct, with laboratory results indicating anemia (low red blood cell count, hemoglobin, and hematocrit), impaired renal function (elevated creatinine and decreased eGFR), and a urinary tract infection (positive nitrite, leukocyte esterase, and bacteria in urinalysis)?

Differential Diagnosis

• Single Most Likely Diagnosis
  • Atrial fibrillation with probable anterolateral infarct: The EKG reading of atrial fibrillation and the presence of a probable anterolateral infarct, as indicated by the EKG, make this the most likely diagnosis. The patient's stable vital signs and lack of acute intracranial abnormalities on the CT head scan also support this diagnosis.
• Other Likely Diagnoses
  • Urinary tract infection (UTI): The urinalysis results showing nitrite, leukocyte esterase, and many bacteria suggest a UTI, which is a common condition in patients with indwelling catheters or those who are elderly.
  • Chronic kidney disease (CKD): The patient's creatinine level of 1.03 and eGFR of 57 suggest some degree of kidney impairment, which may be chronic in nature.
  • Anemia: The patient's low hemoglobin (10.6) and hematocrit (32.6) levels indicate anemia, which could be due to various causes, including chronic disease or blood loss.
• Do Not Miss Diagnoses
  • Pulmonary embolism (PE): Although the D-dimer level is low (0.27), it is not zero, and the patient's anemia and possible chronic kidney disease could increase the risk of PE. Missing a PE could be fatal, so it is essential to consider this diagnosis.
  • Sepsis: The patient's UTI and possible anemia could increase the risk of sepsis, which is a life-threatening condition. Although the patient is currently stable, close monitoring is necessary to detect any signs of sepsis.
  • Cardiac tamponade: The patient's atrial fibrillation and possible anterolateral infarct increase the risk of cardiac tamponade, which is a life-threatening condition that requires immediate attention.
• Rare Diagnoses
  • Thrombotic thrombocytopenic purpura (TTP): The patient's anemia, low platelet count (not explicitly stated but possible), and kidney impairment could suggest TTP, although this is a rare condition.
  • Hemorrhagic stroke: Although the CT head scan did not show any acute intracranial abnormalities, a hemorrhagic stroke could still be possible, especially given the patient's anticoagulation status (INR 1). However, this is less likely given the stable vital signs and lack of acute symptoms.