Differential Diagnosis for 81-year-old Female with Dyspnea and Moderate Tricuspid Regurgitation
- Single most likely diagnosis:
- Tricuspid regurgitation due to annular dilation from right ventricular enlargement, often secondary to left-sided heart failure or pulmonary hypertension. This is likely given the patient's age and the presence of moderate tricuspid regurgitation.
- Other Likely diagnoses:
- Pulmonary hypertension: Can lead to right ventricular enlargement and subsequent tricuspid regurgitation.
- Left-sided heart failure: Often causes pulmonary congestion, leading to pulmonary hypertension and right ventricular strain.
- Cor pulmonale: Right-sided heart failure due to pulmonary disease, which can cause tricuspid regurgitation.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.):
- Pulmonary embolism: Although less likely, it can cause acute right ventricular strain and tricuspid regurgitation, and is potentially life-threatening if not promptly diagnosed and treated.
- Endocarditis of the tricuspid valve: Though uncommon, especially in the absence of other risk factors like intravenous drug use, it's a critical diagnosis not to miss due to its severe consequences.
- Cardiac tamponade: Can cause dyspnea and might lead to tricuspid regurgitation due to the increased pressure affecting the heart's ability to fill properly.
- Rare diagnoses:
- Ebstein's anomaly: A congenital heart defect that affects the tricuspid valve, though it typically presents earlier in life.
- Carcinoid heart disease: A rare condition where a carcinoid tumor secretes substances that can damage the heart valves, particularly the tricuspid valve.
- Traumatic tricuspid regurgitation: Could be a consideration if there's a history of chest trauma, but this would be less common in the context provided.