Patients with chronic right-sided HF are typically not preload dependent. Need to diurese aggressively. Our goal is to make the interventricular septum bow towards the RV and avoid/decrease septal flattening or bulging of the septum towards the LV.

CVP can still be measured in patients with severe TR. Measure CVP at the base of the V wave (just before V wave onset). Though the net load on the central venous system includes the load imposed by the V wave.

In patients with HFpEF with severe functional TR, I try to aggressively diurese to see if reducing RV and RA volume will decrease the tricuspid annulus size and lessen the TR. If not, consider surgical or catheter-based treatment of severe TR, which is often undertreated.