Differential Diagnosis for Right Sided Heart Failure
Single Most Likely Diagnosis
- Pulmonary Hypertension: Given the moderate TR (tricuspid regurgitation) and elevated RVSP (right ventricular systolic pressure) of 35-40mmHg, pulmonary hypertension is a strong consideration. The EF of 60-65% and mild LVH (left ventricular hypertrophy) suggest that left heart function is relatively preserved, pointing towards a primary issue with the right heart or pulmonary vasculature.
Other Likely Diagnoses
- Tricuspid Regurgitation due to Annular Dilatation: The presence of moderate TR could be contributing to right-sided heart failure symptoms, especially if the tricuspid annulus is dilated, leading to significant regurgitation and subsequent right ventricular volume overload.
- Cor Pulmonale: This condition, characterized by right ventricular enlargement and failure secondary to chronic lung disease, could be a consideration given the elevated RVSP. However, more information on lung function and disease would be needed to solidify this diagnosis.
- Cardiac Sarcoidosis or Other Infiltrative Diseases: Although less common, these conditions can lead to right heart failure with preserved left ventricular function. The mild LVH might be incidental or related to another process.
Do Not Miss Diagnoses
- Pulmonary Embolism (Chronic or Acute): A significant and potentially life-threatening condition that could explain the elevated RVSP and right heart strain. Even if less likely, given the chronic nature suggested by moderate TR, it's crucial not to miss this diagnosis.
- Constrictive Pericarditis: This condition can mimic right heart failure and is important to diagnose due to its potential for treatment with pericardiectomy. The presence of mild LVH and preserved EF might not typically point towards constrictive pericarditis, but it remains a critical diagnosis to consider.
Rare Diagnoses
- Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC): A rare condition characterized by fibrofatty replacement of the right ventricular myocardium, leading to dysfunction and potential for arrhythmias. The presence of moderate TR and right heart dysfunction might raise suspicion, especially in younger patients or those with a family history.
- Lymphangiomatosis or Other Rare Pulmonary Vascular Diseases: These conditions are exceedingly rare but could explain pulmonary hypertension and right heart failure in the context of other systemic findings or a suggestive family history.