Differential Diagnosis
The patient's presentation and echocardiogram results suggest several potential diagnoses. These can be categorized as follows:
Single Most Likely Diagnosis
- Aortic Stenosis: The patient has moderate aortic valve stenosis with a peak velocity of 3.43 m/s and a mean gradient of 26 mmHg. This, combined with the patient's age and symptoms of hypertension, makes aortic stenosis the most likely diagnosis. The left ventricular ejection fraction (LVEF) is within a relatively normal range, which is consistent with compensated aortic stenosis.
Other Likely Diagnoses
- Hypertensive Heart Disease: Given the patient's history of hypertension (HTN) and left bundle branch block (LBBB), hypertensive heart disease is a likely contributing factor to the patient's condition. The mild mitral regurgitation and trivial aortic regurgitation could be secondary to hypertensive changes.
- Left Ventricular Hypertrophy: Although not directly stated, the presence of hypertension and aortic stenosis suggests the possibility of left ventricular hypertrophy, which can be a compensatory response to increased afterload.
Do Not Miss Diagnoses
- Cardiac Amyloidosis: Although less common, cardiac amyloidosis can present with heart failure symptoms, preserved ejection fraction, and valvular abnormalities. It's crucial to consider this diagnosis due to its significant implications for treatment and prognosis.
- Coronary Artery Disease: Given the patient's age and the presence of risk factors like hypertension, coronary artery disease should be considered, especially if there are symptoms suggestive of angina or if the ECG shows signs of ischemia.
Rare Diagnoses
- Rheumatic Heart Disease: Although less common in developed countries, rheumatic heart disease can cause valvular abnormalities, including aortic stenosis. However, the patient's age and the absence of other suggestive findings make this a less likely diagnosis.
- Congenital Heart Disease: Certain congenital heart diseases can present later in life, but the patient's age and the specific valvular abnormalities make this a rare consideration in this case.