Differential Diagnosis for 85F with New AFib and Worsening Exertional Fatigue and Palpitations
- Single Most Likely Diagnosis
- Metoprolol-induced bradycardia or excessive beta-blockade: The patient is on metoprolol, a beta-blocker, which can cause bradycardia (slow heart rate) or excessive beta-blockade, leading to worsening exertional fatigue and palpitations, especially in an elderly patient.
- Other Likely Diagnoses
- Decompensated heart failure: The patient's new onset AFib and worsening symptoms could be indicative of underlying heart failure, which may not be well-controlled, leading to fatigue and palpitations.
- Anemia or other hematologic disorders: Anemia is common in the elderly and can cause exertional fatigue and palpitations, which may be exacerbated by the patient's new AFib and medication regimen.
- Electrolyte imbalance (e.g., hypokalemia, hypomagnesemia): Electrolyte imbalances can occur due to various reasons, including medication side effects (e.g., diuretics), and can contribute to arrhythmias, fatigue, and palpitations.
- Do Not Miss Diagnoses
- Cardiac tamponade: Although less likely, cardiac tamponade is a life-threatening condition that can cause fatigue, palpitations, and shortness of breath, and can be a complication of AFib or anticoagulation therapy.
- Pulmonary embolism: The patient is on apixaban, an anticoagulant, but pulmonary embolism is still a possibility, especially if the patient has a history of deep vein thrombosis or other risk factors.
- Hyperthyroidism: Thyrotoxicosis can cause AFib, fatigue, and palpitations, and is a condition that requires prompt diagnosis and treatment to prevent serious complications.
- Rare Diagnoses
- Cardiac sarcoidosis: A rare condition that can cause arrhythmias, including AFib, and heart failure, leading to fatigue and palpitations.
- Amyloidosis: A rare condition that can cause heart failure, arrhythmias, and fatigue, and may be considered in patients with unexplained symptoms and AFib.
- Arrhythmogenic right ventricular cardiomyopathy (ARVC): A rare genetic disorder that can cause arrhythmias, including AFib, and may be considered in patients with a family history of sudden cardiac death or arrhythmias.