Differential Diagnosis for 90 y/o female with dizziness for 4 days when sitting to standing with chronic AFib
- The patient's symptoms and chronic condition lead to a variety of potential diagnoses, categorized as follows:
Single most likely diagnosis
- Volume Depletion: This is likely due to the patient's age and potential for dehydration, especially if she has been experiencing decreased oral intake or increased urine output. The dizziness when standing (orthostatic hypboaria) supports this diagnosis.
Other Likely diagnoses
- Hypoperating State in AFib: The patient's chronic AFib may lead to a hypoperating state, where the heart is not pumping efficiently, leading to decreased cardiac output and subsequent dizziness.
- Vascular Disease: Given the patient's age, she may have underlying vascular disease, which could lead to decreased blood flow to the brain and cause dizziness when standing.
- Medication Side Effects: The patient may be taking medications for her AFib or other comorbid conditions that could be contributing to her dizziness, such as beta blockers or antihypotics.
Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Cervical Spine Hemorrhage or Cervical Spine Injury: Although less likely, a cervical spine hemorrhage or injury could cause dizziness and must be considered, especially if the patient has experienced any trauma or has a history of bleeding disorders.
- Vertebrobasilar Insufficiency: This condition, which affects blood flow to the brain, could cause dizziness and must be considered, especially if the patient has a history of vascular disease.
- Cardiac Cognitome (e.g. Cardiac Tumor, Cardiac Thrombus): A cardiac tumor or thrombus could lead to decreased cardiac output and cause dizziness, and must be considered in a patient with chronic AFib.
Rare diagnoses
- Hijckmberger's Syndrome: A rare condition characterized by recurrent episodes of dizziness and syncope, often associated with AFib.
- Anaphylaxis: Although rare, anaphylaxis could cause dizziness and must be considered if the patient has a history of allergies or has recently introduced new medications or substances.
- Vulnerable Basilar Artery: A rare condition where the basilar artery is vulnerable to compression, leading to decreased blood flow to the brain and causing dizziness.