Differential Diagnosis for 70-year-old Female with Respiratory Symptoms
- Single most likely diagnosis:
- Chronic Obstructive Pulmonary Disease (COPD) exacerbation: The patient's symptoms of wheezing, cough, and chest tightness, particularly the worsening at night and improvement with activity (getting a shower), are consistent with a COPD exacerbation. Her history of smoking is not explicitly mentioned, but her significant past medical history, including CAD and CABG, suggests possible smoking exposure.
- Other Likely diagnoses:
- Asthma: The presence of wheezing, cough, and chest tightness could also suggest asthma, especially if triggered by an upper respiratory infection (suggested by rhinorrhea).
- Acute Bronchitis: This condition, often caused by a viral infection, could explain the cough and chest symptoms, especially if the patient has been experiencing rhinorrhea.
- Heart Failure Exacerbation: Given her history of CHF, an exacerbation could present with respiratory symptoms such as cough and wheezing due to pulmonary congestion.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.):
- Pulmonary Embolism (PE): Although the patient denies chest pain and diaphoresis, PE can sometimes present atypically, especially in the elderly, with symptoms such as cough and wheezing. Her history of CAD and immobility increases her risk.
- Pneumonia: Could present with similar symptoms and is a critical diagnosis to consider due to the potential for severe outcomes, especially in an elderly patient with significant comorbidities.
- Cardiac Ischemia: The patient's history of CAD and CABG puts her at risk for cardiac ischemia, which can sometimes present with atypical symptoms such as cough or wheezing, especially if there is associated heart failure.
- Rare diagnoses:
- Pulmonary Vasculitis: Conditions like Wegener's granulomatosis or other forms of vasculitis could present with respiratory symptoms but are less likely given the patient's presentation and history.
- Bronchiectasis: Could be a consideration if the patient has a history of recurrent infections or specific risk factors, but it's less likely without additional supporting history or findings.