Differential Diagnosis
- Single most likely diagnosis:
- Coronary Artery Disease (CAD) with prior myocardial infarction: The presence of hypokinesis/akinesis in the mid to distal inferoseptal wall and distal inferior wall, which appears thin and hyperechoic, suggests a prior infarct in the territory of the Right Coronary Artery (RCA). The mildly depressed ejection fraction (40-45%) further supports this diagnosis.
- Other Likely diagnoses:
- Hypertensive Heart Disease: The presence of mild concentric left ventricular hypertrophy suggests that hypertension may be contributing to the patient's cardiac condition.
- Cardiomyopathy: The mildly depressed ejection fraction and hypokinesis/akinesis in specific walls could also be seen in cardiomyopathies, although the pattern suggests an ischemic cause.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.):
- Acute Coronary Syndrome: Although the echo suggests a prior infarct, it is crucial to rule out an acute coronary syndrome, especially if the patient presents with chest pain or other suggestive symptoms.
- Cardiac Sarcoidosis: This condition can cause ventricular dysfunction and thinning of the myocardium, similar to what is described, and can have a varied presentation.
- Amyloidosis: Can cause concentric left ventricular hypertrophy and diastolic dysfunction, and although less likely, it is a condition that would significantly alter management.
- Rare diagnoses:
- Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC): The abnormal TAPSE (<1.7 cm) could suggest some degree of right ventricular dysfunction, but the primary findings are more suggestive of left ventricular disease. ARVC is a rare condition that could explain some findings but is less likely given the left ventricular dominance of the disease described.
- Chagas Disease: Can cause cardiomyopathy with areas of wall motion abnormality, but it is rare and typically associated with specific epidemiological factors.