What is the differential diagnosis for her presentation?
Congestive cardiac failure due to
- Ischemic cardiomyopathy
- Idiopathic dilated cardiomyopathy
- Decompensated valvular heart disease.
Transthoracic echo demonstrates severe Mitral Stenosis, moderate Mitral Regurgitation, moderate to severe Tricuspid Regurgitation, normal aortic valve, dilated Right Ventricle, moderate to severely impaired Right Ventricular with septal bowing, Pulmonary Arterial Systolic Pressure of 50mmHg, and an impaired Left Ventricle of normal size.