Differential Diagnosis
- Single most likely diagnosis
- Hypertensive heart disease: The presence of mild asymmetric septal hypertrophy, enlarged left atrium, and reduced LVEF (40-45%) with global hypokinesis suggests chronic hypertension leading to left ventricular remodeling and dysfunction.
- Other Likely diagnoses
- Ischemic cardiomyopathy: Proximal septal akinesis could be indicative of a previous myocardial infarction, and the global hypokinesis with reduced LVEF supports this diagnosis. However, the absence of specific wall motion abnormalities or significant coronary artery disease history makes it less likely than hypertensive heart disease.
- Diabetic cardiomyopathy: This condition can cause global hypokinesis and reduced LVEF without significant coronary artery disease, but the presence of septal hypertrophy and enlarged left atrium points more towards hypertensive heart disease.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Amyloidosis: Although less common, amyloidosis can cause asymmetric septal hypertrophy, diastolic dysfunction, and reduced LVEF. It's crucial to consider this diagnosis due to its poor prognosis and specific treatment options.
- Sarcoidosis: This condition can lead to septal hypertrophy, reduced LVEF, and heart failure. Given its potential for significant morbidity and mortality, it should not be overlooked.
- Rare diagnoses
- Fabry disease: A genetic disorder that can cause asymmetric septal hypertrophy, reduced LVEF, and heart failure. Its rarity and specific treatment options make it a diagnosis to consider in the appropriate clinical context.
- Hypertrophic cardiomyopathy with mid-cavitary obstruction: Although the description mentions mild asymmetric septal hypertrophy, the presence of proximal septal akinesis and reduced LVEF is not typical for hypertrophic cardiomyopathy. However, it remains a rare possibility, especially if there's a family history or other suggestive features.