Differential Diagnosis for Right Heart Failure

To differentiate a condition from right heart failure, we must consider various diagnoses that could present with similar symptoms. The following categories help organize these potential diagnoses:

• Single Most Likely Diagnosis
  • Constrictive Pericarditis: This condition can mimic right heart failure by causing impaired diastolic filling of the heart, leading to similar symptoms such as peripheral edema, ascites, and shortness of breath. Differentiation is crucial as treatment approaches differ significantly.
• Other Likely Diagnoses
  • Chronic Obstructive Pulmonary Disease (COPD): COPD can lead to cor pulmonale, a form of right heart failure, but it can also present with similar symptoms independently, such as shortness of breath and peripheral edema due to pulmonary hypertension.
  • Pulmonary Embolism: Large or multiple pulmonary emboli can cause acute right heart strain or failure, presenting with sudden onset of shortness of breath, chest pain, and potentially syncope.
• Do Not Miss Diagnoses
  • Cardiac Tamponade: Although less common, cardiac tamponade can present with symptoms similar to right heart failure, such as shortness of breath and hypotension. It is critical to diagnose promptly as it is life-threatening and requires immediate intervention.
  • Pulmonary Hypertension: Primary or secondary pulmonary hypertension can lead to right heart failure but may initially present with non-specific symptoms such as shortness of breath and fatigue, making it a crucial diagnosis not to miss.
• Rare Diagnoses
  • Tricuspid Stenosis: A rare valvular heart disease that can cause right heart failure symptoms due to impaired blood flow from the right atrium to the right ventricle.
  • Ebstein’s Anomaly: A congenital heart defect involving the tricuspid valve and right ventricle, which can lead to symptoms similar to right heart failure, including shortness of breath and cyanosis.

Each of these diagnoses requires careful consideration and specific diagnostic tests to differentiate them from right heart failure, ensuring appropriate and timely treatment.