Differential Diagnosis
- Single most likely diagnosis
- Ischemic cardiomyopathy: This diagnosis is the most likely due to the presence of anterolateral ischemia suggested by the EKG results, proximal septal akinesis, and reduced ejection fraction (LVEF of 40-45%). The patient's age and lack of symptoms despite reduced heart function also support this diagnosis.
- Other Likely diagnoses
- Hypertensive heart disease: Given the patient's history and the diagnosis of mild-to-moderate heart failure with reduced ejection fraction, hypertensive heart disease is a plausible cause. The reduced LVEF and symptoms could be attributed to long-standing hypertension.
- Coronary artery disease: The presence of anterolateral ischemia and ST-T wave abnormalities on the EKG suggests some level of coronary artery disease involvement, which could be contributing to the patient's heart failure.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Acute coronary syndrome: Although the patient denies chest pain, the EKG changes and reduced ejection fraction necessitate consideration of acute coronary syndrome, as it could be life-threatening if missed.
- Cardiac arrhythmias: The patient's EKG shows ST-T wave abnormalities, which could be indicative of underlying arrhythmias that might not be immediately apparent but could have significant consequences if left untreated.
- Rare diagnoses
- Dilated cardiomyopathy: Although less likely given the specific EKG findings and suspected anterolateral ischemia, dilated cardiomyopathy could still be a consideration, especially if other causes are ruled out.
- Cardiac sarcoidosis: This rare condition could lead to reduced ejection fraction and heart failure, but it would be less likely without other supporting evidence such as granulomas on biopsy or specific findings on imaging studies.