Differential Diagnosis for a 36-Week Pregnant Patient with Lightheadedness and Occasional Swelling
Single Most Likely Diagnosis
- Preeclampsia: Although the blood pressure is within the normal range, preeclampsia can sometimes present with normal blood pressure readings early in the disease process. The swelling and lightheadedness, combined with the patient being 36 weeks pregnant, make this a strong consideration. Preeclampsia can lead to severe complications if not promptly addressed.
Other Likely Diagnoses
- Normal Pregnancy Symptoms: Swelling of hands, feet, and face, along with lightheadedness, can be common in late pregnancy due to increased blood volume and pressure from the uterus on the vena cava and pelvic veins.
- Anemia: Common in pregnancy due to increased blood volume, anemia can cause lightheadedness and potentially contribute to swelling due to decreased oxygen delivery to tissues.
- Varicose Veins: Pregnancy increases the risk of varicose veins, which can cause swelling in the legs and potentially contribute to feelings of lightheadedness when standing.
Do Not Miss Diagnoses
- Pulmonary Embolism (PE): Although less common, PE is a life-threatening condition that can present with lightheadedness and swelling. Pregnancy increases the risk of PE due to increased blood clotting factors.
- Cardiac Conditions: Pre-existing heart conditions or those that develop during pregnancy (like peripartum cardiomyopathy) can cause lightheadedness and swelling. These conditions are critical to identify due to their potential for severe outcomes.
- Deep Vein Thrombosis (DVT): Similar to PE, DVT is a risk during pregnancy and can cause swelling and potentially lead to lightheadedness if it leads to a PE.
Rare Diagnoses
- Thyroid Storm: Although rare, thyroid disorders can occur during pregnancy and cause symptoms like lightheadedness and swelling.
- Idiopathic Edema of Pregnancy: A condition characterized by edema without proteinuria or hypertension, which could explain the swelling but not necessarily the lightheadedness.
- Nutritional Deficiencies: Deficiencies in nutrients like vitamin B12 or iron (beyond anemia) can cause neurological symptoms including lightheadedness, though they would be less likely to cause swelling.