Differential Diagnosis for 87-year-old Man with Resolved SVT and Troponin Elevation
Single Most Likely Diagnosis
- Myocardial Infarction (MI): The rise in troponin levels from 0.08 to 0.5, although not extremely high, in the context of a recent episode of SVT and left shoulder pain, suggests myocardial injury. The patient's age and history of AF increase the risk for coronary artery disease and MI.
Other Likely Diagnoses
- Myopericarditis: The left shoulder pain during the SVT episode could be referred pain from the pericardium, and the troponin elevation could be due to myocardial inflammation rather than infarction.
- Cardiac Strain from SVT: Prolonged or rapid SVT can cause cardiac strain, leading to troponin elevation without an acute coronary syndrome.
- Chronic Kidney Disease (CKD) related troponin elevation: CKD can cause chronic troponin elevation due to decreased renal clearance, but the acute rise in this case suggests an acute cardiac event.
Do Not Miss Diagnoses
- Aortic Dissection: Although less likely, the left shoulder pain and troponin elevation could be indicative of an aortic dissection, which is a medical emergency. The patient's age and history of hypertension (possibly contributing to CKD) increase the risk.
- Pulmonary Embolism (PE): The left shoulder pain could be referred pain from a PE, and the troponin elevation could be due to right ventricular strain. The patient's history of AF increases the risk for PE.
- Apixaban-related bleeding: Although apixaban is an anticoagulant, it can cause bleeding, and the troponin elevation could be due to cardiac tamponade or other bleeding complications.
Rare Diagnoses
- Takotsubo Cardiomyopathy: The left shoulder pain and troponin elevation could be due to stress-induced cardiomyopathy, although this is less likely in the context of SVT and AF.
- Coronary Artery Spasm: The troponin elevation could be due to coronary artery spasm, which is a rare cause of cardiac chest pain.