Differential Diagnosis for 75-year-old Male Patient
Single Most Likely Diagnosis
- Heart Failure: Given the patient's history of coronary artery disease, recent stenting, and symptoms of shortness of breath and leg pain without chest pain, heart failure is a likely diagnosis. The patient's difficulty walking from one room to another and increased sleepiness could be indicative of decreased cardiac output and potential fluid overload.
Other Likely Diagnoses
- Peripheral Artery Disease (PAD): The patient's history of smoking, hyperlipidemia, and coronary artery disease increases the risk of PAD. Leg pain during walking (claudication) is a classic symptom of PAD, which aligns with the patient's complaints.
- Chronic Obstructive Pulmonary Disease (COPD): Although not directly mentioned, the patient's smoking history puts him at risk for COPD. Shortness of breath and increased sleepiness could be symptoms of COPD, especially if the patient has underlying lung disease.
- Anemia: The patient's symptoms of shortness of breath and fatigue could be indicative of anemia, particularly if there is an underlying cause such as gastrointestinal bleeding (given the patient's age and use of aspirin and Plavix).
Do Not Miss Diagnoses
- Pulmonary Embolism: Although less likely given the lack of chest pain or swelling in the legs, pulmonary embolism is a potentially deadly diagnosis that must be considered, especially in a patient with shortness of breath and a history of recent stenting and immobility.
- Cardiac Tamponade: Given the patient's recent cardiac procedures, cardiac tamponade is a rare but potentially life-threatening condition that could cause shortness of breath and fatigue.
- Aortic Dissection: Although unlikely without chest pain, aortic dissection is a deadly diagnosis that must be considered in patients with a history of hypertension and coronary artery disease.
Rare Diagnoses
- Sleep Apnea: The patient's increased sleepiness could be indicative of sleep apnea, particularly if the patient has underlying risk factors such as obesity (not mentioned).
- Amyloidosis: Given the patient's age and symptoms of shortness of breath and fatigue, amyloidosis is a rare but possible diagnosis that could affect the heart and lungs.
- Sarcoidosis: This rare condition could cause shortness of breath and fatigue, particularly if there is cardiac involvement, but it would be less likely given the patient's presentation and lack of other symptoms.