Differential Diagnosis for Heart Failure
The patient presents with dyspnea, pleural effusion, and lower extremity edema, along with a history of alcohol consumption. The echocardiogram shows increased wall thickening with a preserved ejection fraction. Based on these findings, the differential diagnosis can be categorized as follows:
Single Most Likely Diagnosis
- B. Amyloid Infiltration: The patient's presentation of heart failure with preserved ejection fraction (HFpEF) and increased wall thickening on echocardiogram, in the absence of hypertension or coronary artery disease, suggests an infiltrative cardiomyopathy. Amyloidosis is a condition where abnormal proteins (amyloid) accumulate in the heart, leading to thickened heart walls and restrictive cardiomyopathy. The patient's long history of alcohol use could be a contributing factor, but the echocardiogram findings are more suggestive of an infiltrative process.
Other Likely Diagnoses
- A. Alcoholic Cardiomyopathy: Given the patient's 20-year history of drinking 2-3 beers per week, alcoholic cardiomyopathy is a consideration. However, this condition typically presents with dilated cardiomyopathy and reduced ejection fraction, which does not align with the patient's echocardiogram showing increased wall thickening and a preserved ejection fraction.
- C. Hemochromatosis: This genetic disorder leads to iron overload, which can cause cardiomyopathy. While it's a possibility, the lack of specific findings suggestive of hemochromatosis (e.g., liver enzyme elevations, skin pigmentation) makes it less likely.
Do Not Miss Diagnoses
- D. Hypertensive Heart Disease: Although the patient has no history of high blood pressure, it's essential to consider this diagnosis, as untreated hypertension can lead to heart failure. However, the absence of hypertension in the patient's history and the echocardiogram findings make this less likely.
- E. Ischemic Heart Disease: Despite the patient's lack of history of coronary disease, ischemic heart disease should not be missed, as it can present atypically. The normal EKG and echocardiogram make this less likely, but it should still be considered, especially if the patient has risk factors for coronary artery disease.
Rare Diagnoses
- Other Infiltrative Cardiomyopathies: Conditions like sarcoidosis, Fabry disease, or other storage diseases can cause infiltrative cardiomyopathy. These are less common and would require specific diagnostic testing to confirm.
- Cardiac Sarcoidosis: This condition can cause heart failure and increased wall thickening on echocardiogram. However, it is relatively rare and would require further evaluation, including cardiac MRI or biopsy, to diagnose.