In patients presenting with signs and symptoms of right heart failure an accurate diagnosis of underlying aetiology is vital in order to aid referral for appropriate therapy. Severe tricuspid regurgitation, constrictive pericarditis and restrictive cardiomyopathy may have similar clinical features and findings at cardiac catheterisation including elevation and near equalisation of left and right ventricular diastolic pressures. A recent study has described criteria for distinguishing constrictive pericarditis from restrictive cardiomyopathy, and in this issue of Heart, Jaber et al propose novel haemodynamic criteria for differentiating tricuspid regurgitation from constrictive pericarditis using cardiac catheterisation.
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