Differential Diagnosis for a 58-year-old Male with Progressive Dyspnea
Single Most Likely Diagnosis
- Chronic Heart Failure (CHF): Given the patient's history of hypertension, hyperlipidemia, diabetes, and obesity, CHF is a highly plausible diagnosis. The symptoms of progressive dyspnea, chest tightness/pressure exacerbated by exertion, and chronic pedal edema are consistent with CHF. The fluctuating oxygen levels also support this diagnosis.
Other Likely Diagnoses
- Chronic Obstructive Pulmonary Disease (COPD): Although not directly mentioned, the patient's symptoms of dyspnea and fluctuating oxygen levels could also be indicative of COPD, especially if the patient has a history of smoking or exposure to lung irritants.
- Coronary Artery Disease (CAD): The patient's history of hypertension, hyperlipidemia, and diabetes increases the risk for CAD. The chest tightness/pressure, particularly with exertion, could be angina pectoris, suggesting CAD as a possible diagnosis.
- Pulmonary Embolism (PE): While less likely given the gradual onset of symptoms, PE should be considered, especially if there are any risk factors for thromboembolism such as recent immobilization or family history of clotting disorders.
Do Not Miss Diagnoses
- Pulmonary Embolism (PE): Although mentioned earlier, it's crucial to reiterate PE as a "do not miss" diagnosis due to its high mortality rate if untreated. The patient's symptoms of dyspnea and chest pressure could be indicative of a large or multiple PEs.
- Acute Coronary Syndrome (ACS): The patient's description of chest tightness/pressure, especially if it represents a change from his usual pattern of angina, could indicate an ACS, including myocardial infarction.
- Cardiac Tamponade: Although less common, cardiac tamponade can present with dyspnea, chest pressure, and decreased oxygen saturation. It's a medical emergency requiring prompt diagnosis and treatment.
Rare Diagnoses
- Lymphangitic Carcinomatosis: A rare condition where metastatic cancer infiltrates the lymphatic vessels of the lung, leading to dyspnea and decreased oxygen saturation.
- Pulmonary Vasculitis: Conditions like Wegener's granulomatosis or other forms of vasculitis affecting the pulmonary vessels can present with dyspnea, chest pain, and hypoxemia.
- Congenital Heart Disease: In some cases, congenital heart defects may not be diagnosed until adulthood and could present with symptoms of heart failure or dyspnea.