Differential Diagnosis for Mild TR with Normal PASP and Hyperdynamic LV Systolic Function

• Single Most Likely Diagnosis
  • Hyperthyroidism: This condition can cause hyperdynamic left ventricular (LV) systolic function due to the increased metabolic state and sympathetic drive. Mild tricuspid regurgitation (TR) can be seen due to the increased flow across the tricuspid valve. Normal pulmonary artery systolic pressure (PASP) is consistent with this diagnosis as hyperthyroidism does not typically cause pulmonary hypertension.
• Other Likely Diagnoses
  • Anemia: Similar to hyperthyroidism, anemia can lead to a hyperdynamic circulatory state with increased cardiac output, which may result in mild TR and preserved PASP.
  • Deconditioning or Athlete's Heart: In athletes or individuals with significant deconditioning, the heart may adapt by increasing its size and output, potentially leading to mild TR and hyperdynamic LV function without necessarily affecting PASP.
• Do Not Miss Diagnoses
  • Pulmonary Embolism (PE) with Patent Foramen Ovale (PFO): Although less likely given the normal PASP, a small or recurrent PE could potentially cause mild TR without significantly elevating PASP, especially if there's a right-to-left shunt through a PFO. Missing this diagnosis could be fatal.
  • Cardiac Sarcoidosis: This condition can lead to various cardiac manifestations, including heart failure and valvular dysfunction. Early stages might present with hyperdynamic function and mild TR without significant elevation in PASP.
• Rare Diagnoses
  • Familial Amyloid Polyneuropathy (FAP): A rare condition that can affect the heart, leading to restrictive cardiomyopathy and potentially valvular dysfunction, including TR. However, the presentation with hyperdynamic LV function would be unusual.
  • Left-to-Right Shunt (e.g., Atrial Septal Defect - ASD): While typically associated with increased flow and potentially elevated PASP, small or certain types of shunts might present with mild TR and normal PASP, especially if there's significant LV compensation.