Differential Diagnosis for Uncontrolled Hypertension with Left Ventricular Hypertrophy
Single Most Likely Diagnosis
- B. Diastolic dysfunction: This is the most likely diagnosis given the patient's long-standing hypertension, left ventricular hypertrophy, and a relatively preserved ejection fraction (EF of 55%). Diastolic dysfunction often results from chronic hypertension leading to left ventricular hypertrophy, which impairs the ventricle's ability to relax and fill during diastole.
Other Likely Diagnoses
- A. Hypertrophic cardiomyopathy: Although less common than diastolic dysfunction in the context of long-standing hypertension, hypertrophic cardiomyopathy could present with left ventricular hypertrophy. However, it is typically characterized by asymmetric septal hypertrophy and may have a family history or specific symptoms such as exertional syncope.
- C. Systolic dysfunction: While the EF of 55% is slightly below the normal range (which is typically considered ≥60%), it does not strongly indicate systolic dysfunction, which is usually associated with more significantly reduced ejection fractions (<40%). However, early or mild systolic dysfunction could be considered, especially if there are other signs of heart failure or if the EF has been declining.
Do Not Miss Diagnoses
- Cardiac Amyloidosis: A condition that can cause left ventricular hypertrophy and diastolic dysfunction, often with preserved ejection fraction. It's crucial to consider, especially in older adults or those with a family history, due to its poor prognosis if untreated.
- Fabry Disease: A rare genetic disorder that can lead to left ventricular hypertrophy and may mimic hypertrophic cardiomyopathy. It's essential to consider in younger patients or those with a family history of similar conditions.
Rare Diagnoses
- Restrictive Cardiomyopathy: Characterized by stiff ventricular walls, it can mimic constrictive pericarditis and may present with diastolic dysfunction. It's less common and usually associated with specific etiologies such as amyloidosis, sarcoidosis, or hemochromatosis.
- Left Ventricular Non-compaction: A rare cardiomyopathy characterized by a spongy appearance of the left ventricle due to an arrest in endomyocardial morphogenesis. It may present with left ventricular hypertrophy and systolic or diastolic dysfunction.