What is the most probable diagnosis for a 62-year-old man with hypertension (high blood pressure), presenting with dyspnea (difficulty breathing), orthopnea (shortness of breath while lying down), paroxysmal nocturnal dyspnea (waking up at night with shortness of breath), tachycardia (rapid heart rate), and bilateral pitting edema, with physical examination findings of a third heart sound, bilateral basal coarse crepitations, and hepatomegaly (enlarged liver)?

Differential Diagnosis

• Single most likely diagnosis
  • Heart Failure (HF): The patient's symptoms of orthopnea (improvement in dyspnea after standing by the window for fresh air), paroxysmal nocturnal dyspnea, bilateral pitting edema, third heart sound, and bilateral basal coarse crepitations are classic for heart failure. The patient's history of uncontrolled hypertension also supports this diagnosis, as it is a major risk factor for the development of heart failure.
• Other Likely diagnoses
  • Pulmonary Edema: The patient's symptoms of acute onset dyspnea, orthopnea, and bilateral basal coarse crepitations are consistent with pulmonary edema, which can be a complication of heart failure.
  • Hypertensive Emergency: The patient's severely elevated blood pressure (170/110 mmHg) and symptoms of heart failure suggest a hypertensive emergency, which requires immediate attention to prevent further organ damage.
  • Chronic Kidney Disease (CKD): The patient's history of uncontrolled hypertension and presence of bilateral pitting edema suggest possible CKD, which can contribute to fluid overload and heart failure.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
  • Pulmonary Embolism (PE): Although less likely, PE can present with acute dyspnea, tachypnea, and tachycardia, and can be fatal if missed. The patient's symptoms of cough and dyspnea could be consistent with PE, and it should be considered in the differential diagnosis.
  • Cardiac Tamponade: The patient's symptoms of dyspnea, tachycardia, and hypotension (not present in this case, but could be masked by hypertension) could be consistent with cardiac tamponade, which is a life-threatening condition that requires immediate attention.
• Rare diagnoses
  • Constrictive Pericarditis: The patient's symptoms of dyspnea, orthopnea, and bilateral pitting edema could be consistent with constrictive pericarditis, although it is a rare condition.
  • Cardiac Amyloidosis: The patient's symptoms of dyspnea, orthopnea, and bilateral pitting edema, along with the presence of a third heart sound and soft hepatomegaly, could be consistent with cardiac amyloidosis, although it is a rare condition.