Differential Diagnosis for Hypotension, Congestive Cardiac Failure, and Hypoalbuminemia

Single Most Likely Diagnosis

• Nephrotic Syndrome: This condition is characterized by heavy proteinuria, hypoalbuminemia, and edema. The low blood pressure (90/60 mmHg) could be due to decreased intravascular volume from nephrotic syndrome, and congestive cardiac failure (CCF) might be a complication of long-standing nephrotic syndrome or related to other cardiac issues.

Other Likely Diagnoses

• Heart Failure with Reduced Ejection Fraction (HFrEF): Hypoalbuminemia can be seen in advanced heart failure due to liver congestion and decreased albumin synthesis. CCF and hypotension are common in HFrEF.
• Cirrhosis with Cardiac Involvement: Liver cirrhosis can cause hypoalbuminemia due to decreased liver function. Cardiac involvement, such as cirrhotic cardiomyopathy, can lead to CCF and hypotension.
• Severe Malnutrition: Malnutrition can cause hypoalbuminemia and may lead to cardiac dysfunction and CCF. Hypotension can be due to dehydration or cardiac dysfunction.

Do Not Miss Diagnoses

• Septic Shock: Although less likely, septic shock can present with hypotension, CCF (due to myocardial depression), and hypoalbuminemia (due to capillary leak syndrome). Missing this diagnosis can be fatal.
• Cardiac Tamponade: This condition can cause hypotension and CCF. Hypoalbuminemia might not be directly related but could be present in the context of a broader clinical picture.
• Hemorrhagic Shock: Internal bleeding can lead to hypotension, and if severe, can cause CCF. Hypoalbuminemia might be seen if there's significant blood loss or if the patient has a pre-existing condition affecting albumin levels.

Rare Diagnoses

• Constrictive Pericarditis: A rare condition that can cause CCF and hypotension. Hypoalbuminemia might be present due to associated conditions or malnutrition.
• Tricuspid Regurgitation with Severe Right Heart Failure: This can lead to CCF, hypotension, and potentially hypoalbuminemia due to liver congestion.
• Amyloidosis: A rare condition that can cause cardiac involvement leading to CCF and hypotension. Hypoalbuminemia can be seen due to nephrotic syndrome caused by amyloid deposits in the kidneys.