[57F] Experiencing shortness of breath, fatigue, and fast heartbeat

Shortness of Breath and Elevated Heart Rate

Differential diagnosis

• Given the patient's history of MS, autonomic dysfunction (G90.9) could be a possible cause of her symptoms.
• Other possible causes include heart failure (I50.9), anemia (D64.9), hyperthyroidism (E05.90), and anxiety (F41.9).

Plan

Perform a physical exam and order a complete blood count (CBC) to check for anemia. Also, order thyroid function tests to rule out hyperthyroidism. An EKG and echocardiogram may be necessary to evaluate heart function. If these tests are inconclusive, consider referral to a cardiologist or neurologist for further evaluation.

Loss of Appetite

Differential diagnosis

• Possible causes include depression (F32.9), side effect of medication (T88.7), gastrointestinal disorder (K92.9), and malignancy (C80.1).

Plan

Review the patient's medication list for potential side effects. Order a comprehensive metabolic panel (CMP) to check liver and kidney function. If symptoms persist, consider referral to a gastroenterologist for further evaluation.

Hot Flashes

Differential diagnosis

• Given the patient's age, menopause (N95.1) is the most likely cause of her hot flashes.
• Other possible causes include side effect of medication (T88.7), hyperthyroidism (E05.90), and carcinoid syndrome (E34.0).

Plan

Order thyroid function tests to rule out hyperthyroidism. Review the patient's medication list for potential side effects. If symptoms persist, consider referral to an endocrinologist for further evaluation.