Differential Diagnosis for 80 yo Male with Leg Discoloration and Concerns about Heart Attack

• Single most likely diagnosis:
  • Chronic Venous Insufficiency: The patient's symptoms of black and blue discoloration and red blotches up to the knees, particularly in the context of improved circulation with Eliquis (a blood thinner), suggest a condition affecting venous return. Chronic venous insufficiency is common in the elderly and can cause skin changes and discoloration due to poor blood circulation back to the heart.
• Other Likely diagnoses:
  • Deep Vein Thrombosis (DVT): Although the patient is on anticoagulants, the presence of red blotches and worsening condition in the lower legs could indicate a DVT, especially if the anticoagulation therapy is not adequately effective.
  • Peripheral Artery Disease (PAD): This condition involves narrowing of the arteries, which can lead to reduced blood flow to the limbs, causing pain, discoloration, and potentially worsening symptoms over time.
  • Hemorrhagic Dermatosis: Given the patient's anticoagulation therapy, there's a possibility of hemorrhagic dermatosis, where bleeding into the skin causes discoloration.
• Do Not Miss diagnoses:
  • Pulmonary Embolism: Although the patient's symptoms are localized to the legs, it's crucial not to miss the possibility of a pulmonary embolism, especially in someone with a history of blood circulation issues and anticoagulant use. A pulmonary embolism can be life-threatening and may not always present with typical symptoms.
  • Cardiac Ischemia/Myocardial Infarction: The patient's concern about nearing a heart attack should be taken seriously. Any signs of cardiac ischemia or myocardial infarction need immediate attention due to their high mortality rate if not promptly treated.
• Rare diagnoses:
  • Vasculitis: Inflammation of the blood vessels can cause a variety of symptoms including skin discoloration and could be a rare cause of this patient's presentation.
  • Sickle Cell Disease Crisis: Although less likely given the patient's age and presentation, sickle cell disease can cause vaso-occlusive crises leading to tissue ischemia and potentially similar symptoms. However, this would be extremely rare in an 80-year-old without a previous diagnosis.