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Isolated Right Heart Failure — EECC MCQ

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ModerateHeart FailureIsolated Right Heart FailureEECC

A 75-year-old man presents with progressive breathlessness and peripheral oedema. Echocardiography shows LVEF 55%, moderate TR, dilated IVC (28 mm, no respiratory variation), RV dilatation with TAPSE 12 mm, and normal LV dimensions. There is no significant left-sided valve disease. Which condition is the most likely primary diagnosis?

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Correct answer: C — Isolated right heart failure due to pulmonary hypertension

The combination of RV dilatation, severely reduced TAPSE (<17 mm), dilated non-collapsing IVC (indicating elevated RA pressure), moderate TR, and preserved LV function with normal LV dimensions points to isolated right heart failure, most likely secondary to pulmonary hypertension. The key distinguishing features from HFpEF are the normal LV dimensions and absence of LV diastolic dysfunction markers. Right heart catheterisation is essential to confirm the diagnosis and classify the PH. The 2022 ESC/ERS PH Guidelines define RV dysfunction by TAPSE <17 mm as a prognostic marker.

Reference: ESC (2022): Guidelines for Pulmonary Hypertension