Differential Diagnosis
- Single most likely diagnosis
- Infective Endocarditis: This is the most likely diagnosis given the patient's history of Rheumatic Heart Disease (RHD), recent onset of exertional dyspnea, orthopnea, and bipedal edema, and the presence of vegetation on the mitral valve seen on 2D echo. The patient's symptoms and the echocardiographic findings are highly suggestive of infective endocarditis, a known complication of RHD.
- Other Likely diagnoses
- Heart Failure: Given the patient's history of RHD and symptoms of exertional dyspnea, orthopnea, and bipedal edema, heart failure is a plausible diagnosis. The recent worsening of symptoms could indicate decompensated heart failure.
- Mitral Stenosis: As a complication of RHD, mitral stenosis could lead to symptoms similar to those presented by the patient, including dyspnea and edema, due to obstructed blood flow.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Pulmonary Embolism: Although less likely, pulmonary embolism could present with sudden onset dyspnea and could be fatal if not promptly diagnosed and treated. The absence of chest pain and other typical symptoms does not rule out this diagnosis.
- Cardiac Tamponade: This is a life-threatening condition that could arise from complications of RHD or infective endocarditis, characterized by impaired heart function due to fluid accumulation in the pericardial sac. It presents with dyspnea, hypotension, and possibly jugular venous distension.
- Rare diagnoses
- Marantic Endocarditis: Also known as non-bacterial thrombotic endocarditis, this condition involves the formation of sterile vegetations on heart valves, often associated with hypercoagulable states or malignancy. It's less likely but could be considered if other diagnoses are ruled out.
- Libman-Sacks Endocarditis: This is a form of non-bacterial endocarditis associated with systemic lupus erythematosus (SLE) or antiphospholipid syndrome, characterized by the formation of vegetations on either side of the valve leaflets. It's rare and would require specific diagnostic criteria to be considered.