Differential Diagnosis
- Single most likely diagnosis
- Atrial fibrillation with probable anterolateral infarct: The EKG reading of atrial fibrillation and probable anterolateral infarct, age indeterminate, suggests a cardiac issue that may be related to the patient's current condition. The presence of pacemaker spikes or artifacts on the EKG also supports a cardiac-related diagnosis.
- Other Likely diagnoses
- Urinary tract infection (UTI): The urinalysis results showing positive nitrite, leukocyte esterase, and many bacteria indicate a likely UTI. The patient's symptoms and lab results support this diagnosis.
- Anemia: The CBC results showing low RBC, hemoglobin, and hematocrit levels suggest anemia, which could be contributing to the patient's condition.
- Chronic kidney disease: The elevated creatinine level and chronic microvascular ischemic changes on the CT head scan suggest possible chronic kidney disease.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Pulmonary embolism: Although the D-dimer level is low (0.27), it is not entirely ruled out, and pulmonary embolism can be deadly if missed. Further evaluation may be necessary to confirm or rule out this diagnosis.
- Sepsis: The presence of a UTI and abnormal lab results (e.g., low RBC, hemoglobin, and hematocrit) increases the risk of sepsis, which can be life-threatening if not promptly treated.
- Cardiac tamponade: The presence of pacemaker spikes or artifacts on the EKG and probable anterolateral infarct increases the risk of cardiac tamponade, which is a life-threatening condition requiring immediate attention.
- Rare diagnoses
- Thrombophlebitis: Although the D-dimer level is low, thrombophlebitis is a rare but possible diagnosis that could be contributing to the patient's condition.
- Paroxysmal nocturnal hemoglobinuria (PNH): The low RBC, hemoglobin, and hematocrit levels could be indicative of a rare condition like PNH, although it is unlikely.
- Cardiac sarcoidosis: The presence of pacemaker spikes or artifacts on the EKG and probable anterolateral infarct could be related to a rare condition like cardiac sarcoidosis, although it is unlikely without further evaluation.