Differential Diagnosis for a 26 Weeks Pregnant 33-Year-Old Female with Intermittent Shortness of Breath and Echo Showing Diastolic Dysfunction of the Right Ventricle
- Single Most Likely Diagnosis
- Normal Pregnancy-Related Cardiovascular Changes: Pregnancy can cause physiological changes that may lead to shortness of breath and alterations in cardiac function, including increased blood volume and cardiac output. The diastolic dysfunction of the right ventricle could be an adaptive response to these changes.
- Other Likely Diagnoses
- Pulmonary Embolism: Although less common, pulmonary embolism can occur during pregnancy due to increased coagulability of blood. It can cause shortness of breath and right ventricular strain.
- Anemia of Pregnancy: Anemia can lead to shortness of breath and may affect cardiac function due to increased demand for oxygen delivery.
- Pregnancy-Induced Hypertension: Can lead to cardiac dysfunction, including diastolic dysfunction, due to increased afterload.
- Do Not Miss Diagnoses
- Pulmonary Hypertension: A condition that can be exacerbated by pregnancy and leads to right ventricular dysfunction. It's crucial to diagnose due to its high mortality rate if untreated.
- Cardiomyopathy (Peripartum or Pre-existing): Conditions like peripartum cardiomyopathy can present with symptoms of heart failure and diastolic dysfunction, posing significant risk to both mother and fetus.
- Aortic Dissection: Although rare, it's a catastrophic condition that can present with shortness of breath and can be associated with pregnancy due to hormonal effects on the aortic wall.
- Rare Diagnoses
- Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC): A rare condition that affects the right ventricle, leading to dysfunction and potentially life-threatening arrhythmias.
- Eisenmenger Syndrome: A rare condition in pregnancy due to the closure of cardiac shunts, but if present, it can lead to significant morbidity and mortality due to pulmonary hypertension and right ventricular dysfunction.
- Mitral Stenosis: Although more commonly associated with left-sided heart disease, severe mitral stenosis can lead to right ventricular dysfunction due to increased pulmonary pressures, especially in the context of increased blood volume during pregnancy.