Differential Diagnosis for Chest Tightness, Shortness of Breath, and Leg Swelling
Single Most Likely Diagnosis
- Heart Failure: This condition is characterized by the heart's inability to pump enough blood to meet the body's demands, leading to fluid buildup in the lungs (causing shortness of breath and chest tightness) and peripheral tissues (resulting in leg swelling). The combination of these symptoms strongly suggests heart failure as a primary consideration.
Other Likely Diagnoses
- Chronic Obstructive Pulmonary Disease (COPD) Exacerbation: COPD can cause shortness of breath and chest tightness due to airway obstruction. While leg swelling is not a direct symptom of COPD, it can occur in the context of right heart failure secondary to COPD (cor pulmonale).
- Pulmonary Embolism: Although more commonly associated with sudden onset of symptoms, pulmonary embolism can cause shortness of breath and chest pain. Leg swelling could be related to a deep vein thrombosis (DVT), which is often a precursor to pulmonary embolism.
- Anxiety or Panic Disorder: These conditions can manifest with chest tightness and shortness of breath. While leg swelling is not typically associated with anxiety or panic disorders, it could be related to decreased mobility or other secondary factors.
Do Not Miss Diagnoses
- Pulmonary Hypertension: A condition characterized by high blood pressure in the arteries of the lungs, leading to right heart failure. It can cause all the mentioned symptoms and is critical not to miss due to its severe prognosis and specific treatment options.
- Cardiac Tamponade: Fluid accumulation in the pericardial sac can compress the heart, impairing its function. This is a medical emergency that can present with chest tightness, shortness of breath, and potentially leg swelling due to decreased cardiac output.
- Aortic Dissection: Although it typically presents with severe, tearing chest pain, aortic dissection can lead to cardiac tamponade, aortic regurgitation, or other complications that might result in the described symptoms.
Rare Diagnoses
- Lymphangitis or Lymphedema: Conditions affecting the lymphatic system can cause leg swelling. While they are less likely to cause chest tightness and shortness of breath directly, in rare cases, they could be part of a broader syndrome or have secondary effects that contribute to these symptoms.
- Superior Vena Cava Syndrome: Obstruction of the superior vena cava can cause shortness of breath and chest tightness due to increased pressure in the veins of the upper body. Leg swelling would be an unusual presentation but could occur in specific contexts, such as with a large mediastinal mass affecting both venous return and cardiac function.
- Constrictive Pericarditis: A condition where the pericardium becomes stiff and unable to stretch, restricting heart filling. It can cause shortness of breath, chest tightness, and leg swelling due to impaired cardiac function, but it is less common than other cardiac conditions.