Differential Diagnosis for 61-year-old Male Patient with EKG Findings

The patient's EKG shows sinus rhythm, prolonged P wave, T wave abnormality, particularly in leads V1, V2, V3, and V5. Based on these findings, the differential diagnosis can be categorized as follows:

• Single Most Likely Diagnosis

  • Left Ventricular Hypertrophy (LVH): The presence of a prolonged P wave (indicative of left atrial enlargement) and T wave abnormalities in the anterior and lateral leads (V1-V3 and V5) can suggest LVH. This condition is common in hypertensive patients and can lead to these EKG changes due to increased left ventricular muscle mass.

• Other Likely Diagnoses

  • Coronary Artery Disease (CAD): T wave abnormalities, especially in leads V1-V3 and V5, can indicate ischemia or infarction, which are common manifestations of CAD. The patient's age and potential risk factors (e.g., hypertension, diabetes, smoking) increase the likelihood of CAD.
  • Hypertension: Chronic hypertension can lead to left ventricular hypertrophy and left atrial enlargement, explaining the prolonged P wave and T wave changes. Hypertension is a common condition in this age group and can cause these EKG findings.
  • Cardiomyopathy: Various forms of cardiomyopathy (e.g., hypertrophic, dilated) can cause EKG abnormalities, including T wave changes and signs of chamber enlargement. The patient's symptoms and other diagnostic findings would help differentiate among these conditions.

• Do Not Miss Diagnoses

  • Myocardial Infarction (MI): Although the EKG does not show classic ST-elevation, T wave inversions, especially in leads V1-V3 and V5, can be a sign of non-ST elevation MI (NSTEMI) or a previous MI. Missing an MI can have severe consequences, making it crucial to consider and rule out with further testing (e.g., troponins).
  • Pulmonary Embolism (PE): While less common, a PE can cause T wave inversions in the anterior leads (V1-V4) and should be considered, especially if the patient has symptoms like acute onset dyspnea or chest pain. The consequences of missing a PE can be fatal.

• Rare Diagnoses

  • Cardiac Sarcoidosis: This condition can cause various EKG abnormalities, including T wave inversions and signs of heart block. It is less common but should be considered in patients with unexplained EKG changes and systemic symptoms.
  • Amyloidosis: Cardiac involvement in amyloidosis can lead to EKG abnormalities, including low voltage QRS complexes and T wave inversions. It is a rare condition but important to consider in patients with systemic symptoms and unexplained cardiac findings.