Differential Diagnosis for Right Sided Heart Failure
Single Most Likely Diagnosis
- Right Ventricular Dysfunction due to Tricuspid Regurgitation: Given the presence of moderate TR and RVSP of 35-40mmHg, it is likely that the tricuspid regurgitation is causing right ventricular dysfunction, which can lead to right-sided heart failure. The EF of 60-65% and mild LVH suggest that left ventricular function is relatively preserved.
Other Likely Diagnoses
- Non-cardiac Causes of Right Heart Failure: Conditions such as pulmonary embolism, COPD, or pneumonia can cause right heart failure due to increased pulmonary resistance. Although not directly indicated by the provided information, these conditions are often considered in the context of right heart failure.
- Cardiomyopathy: Although the EF is within a relatively normal range, certain types of cardiomyopathy (e.g., arrhythmogenic right ventricular cardiomyopathy) could lead to right ventricular dysfunction and heart failure.
Do Not Miss Diagnoses
- Pulmonary Embolism: A significant and potentially life-threatening condition that can cause acute right heart failure. It is crucial to rule out pulmonary embolism, especially if there is a sudden onset of symptoms or if the patient has risk factors for thromboembolism.
- Cor Pulmonale: This condition, characterized by right ventricular enlargement and failure due to pulmonary disease, is critical to consider, especially if there is a history of respiratory disease.
Rare Diagnoses
- Congenital Heart Disease: Conditions like Ebstein's anomaly or other congenital heart defects involving the tricuspid valve could lead to right heart failure, although these would typically be diagnosed earlier in life.
- Lymphatic or Pericardial Disease: Rare conditions affecting the lymphatic system or pericardium, such as constrictive pericarditis, can mimic right heart failure and should be considered if other diagnoses are ruled out.