Differential Diagnosis for 90 year old female with dizziness, history of vertigo, and afib
- The patient's symptoms of dizziness, history of vertigo, and atrial fibrillation (afib) can be caused by various conditions. Here is a differential diagnosis, categorized for clarity:
Single most likely diagnosis
- Vulnerable Atrial Fibrillation with Embolic Phenomena: The patient's history of afib increases the risk of embolic events, which can cause dizziness due to decreased cerebral perfusion. The age of the patient and the presence of afib make this a highly likely diagnosis.
Other Likely diagnoses
- Vestibular Disorder (e.g., Vertigo, Vestibular Neuritis): Given the patient's history of vertigo, a vestibular disorder is a plausible cause of her dizziness. Age-related decline in vestibular function could exacerbate symptoms.
- Cerebrovascular Disease: The patient's age and history of afib increase the risk of cerebrovascular disease, which can cause dizziness due to decreased blood flow to the brain.
- Orthostatic Hypotension: This condition, common in the elderly, can cause dizziness due to a drop in blood pressure when standing up.
Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Cervical Spine Hemorrhage or Cervical Vertebrae Fracture: Although less likely, these conditions can cause dizziness and are potentially life-threatening if missed. The patient's age increases the risk of osteoporosis and subsequent fractures.
- Stroke or Transient Ischemic Attack (TIA): Given the patient's history of afib, a stroke or TIA is a critical diagnosis to consider, as it can cause dizziness and have severe consequences if not promptly treated.
- Hijack Maneuvers or other Cardiac Causes: Other cardiac conditions, such as cardiac tamponade or aortic stenosis, can cause dizziness and are potentially life-threatening.
Rare diagnoses
- Cancer-Related Dizziness: Although rare, cancer (e.g., cerebellopontine angle tumors) can cause dizziness, especially in older adults.
- Infectious Causes (e.g., Lyme Disease, Sepsis): Certain infections can cause dizziness, particularly in older adults with compromised immune systems.
- Medication Side Effects: The patient's current medication regimen may be contributing to her dizziness, especially if she is taking multiple medications that can cause dizziness as a side effect.