Differential Diagnosis for 86 year-old female with history of diabetes, hypertension, pulmonary hypertension, a fib on Coumadin, presenting with hypoxia, hypertension, tachycardia, and fever
- Single most likely diagnosis
- Pneumonia: Given the patient's age, symptoms of hypoxia, fever, and tachycardia, pneumonia is a highly likely diagnosis. The patient's history of pulmonary hypertension may also increase her susceptibility to respiratory infections.
- Other Likely diagnoses
- Pulmonary embolism (PE): The patient's history of atrial fibrillation and use of Coumadin increases her risk for thromboembolic events. Hypoxia, tachycardia, and hypertension are consistent with a PE.
- Sepsis: The patient's fever, tachycardia, and hypoxia could indicate a systemic infection, which could be related to her diabetes or other comorbidities.
- Acute coronary syndrome (ACS): Although less likely given the patient's presentation, ACS could cause hypoxia, hypertension, and tachycardia, especially in a patient with a history of hypertension.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Cardiac tamponade: The patient's history of atrial fibrillation and anticoagulation with Coumadin increases her risk for cardiac tamponade, which could present with hypoxia, tachycardia, and hypertension.
- Massive hemoptysis: Although less likely, the patient's pulmonary hypertension and anticoagulation increase her risk for massive hemoptysis, which would be life-threatening.
- Aortic dissection: The patient's history of hypertension increases her risk for aortic dissection, which could present with hypoxia, tachycardia, and hypertension.
- Rare diagnoses
- Pulmonary vasculitis: This is a rare condition that could cause hypoxia, fever, and tachycardia, but it would be less likely given the patient's presentation and history.
- Amniotic fluid embolism: This is an extremely rare condition that would be unlikely in an 86-year-old female, but it could present with hypoxia, tachycardia, and hypertension.