Differential Diagnosis
The patient's presentation of right-sided weakness, facial droop, shortness of breath, and a blowing, holosystolic murmur, along with a history of hypertension and hyperlipidemia, suggests several potential diagnoses. These can be categorized as follows:
Single Most Likely Diagnosis
- Acute Ischemic Stroke: The patient's right-sided weakness and facial droop are classic signs of a stroke, particularly an ischemic stroke given the absence of other symptoms like headache or seizure. The history of hypertension and hyperlipidemia increases the risk for atherosclerosis and subsequent stroke.
Other Likely Diagnoses
- Myocardial Infarction (MI): Although the patient's BP and HR are within normal limits, the shortness of breath and the presence of a holosystolic murmur could indicate cardiac involvement. An MI could lead to a new murmur due to papillary muscle dysfunction or ventricular septal defect.
- Pneumonia: The patient's symptoms of being "under the weather," feverish, and short of breath could suggest a respiratory infection like pneumonia, which might be contributing to her overall condition.
- Endocarditis: The new onset of a holosystolic murmur, even without a known history of cardiac disease, could suggest endocarditis, especially if the patient has been feverish. However, this would typically be accompanied by other signs such as Janeway lesions or Roth spots.
Do Not Miss Diagnoses
- Aortic Dissection: Although less likely given the absence of severe chest or back pain, an aortic dissection could present with a new murmur and could be catastrophic if missed. The patient's history of hypertension increases the risk.
- Pulmonary Embolism (PE): The shortness of breath and recent history of being "under the weather" could also suggest a PE, which is critical to diagnose and treat promptly to prevent mortality.
- Infective Endocarditis with Embolic Stroke: If the patient has endocarditis, there's a risk of embolic phenomena, including stroke, which would explain the neurological symptoms.
Rare Diagnoses
- Mitral Valve Prolapse with Embolic Event: While mitral valve prolapse is not uncommon, it rarely leads to embolic events. However, it could potentially explain the new murmur and the stroke-like symptoms if an embolus occurred.
- Cardiac Tumor (e.g., Myxoma): A cardiac tumor could cause a new murmur and potentially embolic phenomena leading to stroke. However, this is much less common and would typically be associated with other systemic symptoms.
- Vasculitis (e.g., Giant Cell Arteritis): Although rare, vasculitis could potentially explain the combination of stroke-like symptoms and a new cardiac murmur, especially if there are other systemic symptoms such as headache, jaw claudication, or visual disturbances.