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The WikiDoc Living Textbook of Cardiology
2020-05-27T20:29:02Z
<p>Ifeoma odukwe: /* List of Chapters Requiring Content */</p>
<hr />
<div>__NOTOC__<br />
<br />
== List of Chapters Requiring Content ==<br />
<br />
* Blalock-Taussig procedure<br />
* Bridge to transplant (assigned)<br />
* Cardiac transplant (assigned)<br />
* Cardiopulmonary resuscitation (Assigned)<br />
*Catecholaminergic Polymorphic Ventricular Tachycardia (CPVT)<br />
* Collateral circulation<br />
* Coronary artery bypass grafting <br />
* Holter monitor<br />
* Hypokalemia (assigned)<br />
* Myxomatous degeneration<br />
* Paget-Schroetter disease (Assigned)<br />
*Palpitation(assigned)<br />
* Paroxysmal supraventricular tachycardia (assigned)<br />
* Paroxysmal AV block(assigned)<br />
*Paradoxical embolism (assigned)<br />
*Paradoxical septal motion (assigned)<br />
* Persistent juvenile T-wave pattern<br />
*Post-cardiac injury syndrome<br />
*Post-infarction conduction abnormalities<br />
*PR interval alternans<br />
* Pre-excitation syndrome (assigned)<br />
*Pulseless ventricular tachycardia(assigned)<br />
*Short QT Syndrome (SQTS) <br />
*Transesophageal echocardiography<br />
<br />
<br /><br />
<br />
==[[:Category:Cardiology|Alphabetical Index of all Pages in the Cardiology Textbook]]==<br />
<br />
=ANATOMY=<br />
==[[Cardiovascular Anatomy]]==<br />
<small> '''Arteries''' | [[Coronary arteries]] | [[Arteries of the head and neck|Head and Neck]] | [[Arteries of the upper limbs|Upper Limbs]] | [[Arteries of the torso-chest|Torso-Chest]] | [[Arteries of the torso-abdomen|Torso-Abdomen]] | [[Arteries of the lower limbs|Lower Limbs]] | [[Artery|All]] </small><br />
<br />
<small> '''Veins''' | [[Veins of the head and neck|Head and Neck]] | [[Veins of the upper extremity |Upper Extremity]] | [[Veins of the torso|Torso]] | [[Veins of the lower extremity|Lower Extremity]]</small><br />
<br />
<small> '''Atria''' | [[Atrium (heart)|Atria]] | [[Left atrium]] | [[Right atrium]] | [[Interatrial septum]] | [[Musculi pectinati]]</small><br />
<br />
<small>'''Ventricles''' | [[Ventricle (heart)|Ventricles]] | [[Left ventricle]] | [[Right ventricle]] | [[Interventricular septum]] | [[Trabeculae carneae]] | [[Chordae tendinae]] | [[Papillary muscle]]</small><br />
<br />
<small>'''Valves''' | [[Heart valve|Valves]] | [[Aortic valve]] | [[Mitral valve]] | [[Pulmonic valve]] | [[Tricuspid valve]] | [[Cusps of heart valves|Cusps]]</small><br />
<br />
<small>'''Regions''' | [[Base of the heart|Base]] | [[Apex of the heart|Apex]]</small> <br />
<br />
<small> '''Grooves''' | [[Coronary sulcus|Coronary/atrioventricular]] | [[Interatrial groove|Interatrial]] | [[Anterior interventricular sulcus|Anterior interventricular]] | [[Posterior interventricular sulcus|Posterior interventricular]] </small><br />
<br />
<small> '''Surfaces''' | [[Sternocostal surface|Sternocostal]] | [[Diaphragmatic surface of heart|Diaphragmatic]] </small><br />
<br />
<small>'''Borders''' | [[Right border of heart|Right]] | [[Left margin of heart|Left]]</small><br />
<br />
<small>'''Right heart''' | [[Vena cavae]] | [[Coronary sinus]] | [[Right atrium]] | [[Right auricular appendix|Right auricle]] | [[Fossa ovalis (heart)|Fossa ovalis]] | [[Limbus of fossa ovalis]] | [[Crista terminalis]] | [[Valve of the inferior vena cava]] | [[Valve of the coronary sinus]] | [[Tricuspid valve]] | [[Right ventricle]] | [[Conus arteriosus]] | [[Septomarginal trabecula|Moderator band/septomarginal trabecula]] | [[Pulmonary valve]] | [[Pulmonary artery]] | [[Pulmonary circulation]]</small><br />
<br />
<small> '''Left heart''' | [[Pulmonary veins]] | [[Left atrium]] | [[Left auricular appendix|Left Auricle]] | [[Mitral valve]] | [[Left ventricle]] | [[Aortic valve]] | [[Aortic sinus]] | [[Aorta]] | [[Systemic circulation]]</small><br />
<br />
<small> '''Pericardium''' | [[Pericardium]] | [[Fibrous pericardium]] | [[Serous pericardium]] | [[Pericardial cavity]] | [[Epicardium|Epicardium/visceral layer]] | [[Pericardial sinus]]</small><br />
<br />
<small> '''Myocardium''' | [[Myocardium]] | [[Endocardium]] | [[Cardiac skeleton]] | [[Fibrous trigone]] | [[Fibrous rings of heart|Fibrous rings]]</small><br />
<br />
<small>'''Conduction system''' | [[Electrical conduction system of the heart|Conduction system]] | [[Cardiac pacemaker]] | [[SA node]] | [[AV node]] | [[Bundle of His]] | [[Purkinje fibers]]</small><br />
<br><br />
<br />
=PHYSIOLOGY=<br />
==[[Cardiovascular Physiology]]==<br />
<small>'''Volumes''' | [[Preload]] | [[Afterload]] | [[End-systolic volume]] | [[End-diastolic volume]] | [[Frank-Starling law of the heart]] | [[Cardiac output]]</small><br />
<br />
<small> '''Interactions''' | [[Wiggers diagram]] | [[Pressure volume diagram]]</small><br />
<br />
<small> '''Tropism''' | [[Chronotropic|Chronotropy]] | [[Dromotropic|Dromotropy]] | [[Inotropic|Inotropy]]</small><br />
<br />
<small> '''Hemodynamics''' | [[Hemodynamics]] | [[Baroreflex|Baroreflexes]] | [[Kinin-kallikrein system]] | [[Renin-angiotensin system]] | [[Vasoconstrictors]] | [[Vasodilator|Vasodilators]] | [[Compliance (physiology)|Compliance]] | [[Vascular resistance]]</small><br />
<br />
<small>'''Conduction''' | [[Electrical conduction system of the heart ]]| [[Cardiac action potential]] </small><br />
<br />
<small> '''Cardiopulmonary''' | [[Respiratory physiology]] | [[Blood]] | [[Pulmonary circulation]] | [[Perfusion|Perfusion (Q)]] | [[Hypoxic pulmonary vasoconstriction]] | [[Pulmonary shunt]] | [[Ventilation/perfusion scan]] | [[ventilation/perfusion ratio]] (V/Q) | [[Zones of the lung]] | [[Gas exchange]] | [[Pulmonary gas pressures]] | [[Alveolar gas equation]] | [[Hemoglobin]] | [[Oxygen-haemoglobin dissociation curve]] | [[2,3-Bisphosphoglycerate|2,3-DPG]] | [[Bohr effect]] | [[Haldane effect]] | [[Carbonic anhydrase]] | [[Chloride shift]] | [[Oxyhemoglobin]] | [[Respiratory quotient]] | [[Arterial blood gas]] | [[Diffusion capacity]] | [[Dlco]] </small><br />
<br />
=DEVELOPMENTAL BIOLOGY=<br />
==[[Cardiovascular Development]]==<br />
<small>'''Arteries''' | [[Dorsal aorta]] | [[Aortic arches]] | [[Vitelline arteries]] | [[Ductus arteriosus]] | [[Umbilical artery]]</small><br />
<br />
<small>'''Veins''' | [[Cardinal veins]] | [[Ducts of Cuvier]] | [[Vitelline veins]] | [[Ductus venosus]] | [[Umbilical vein]]</small><br />
<br />
<small>'''Heart Development''' | [[Primitive heart tube]] | [[Truncus arteriosus]] | [[Bulbus cordis]] | [[Primitive ventricle]] | [[Primitive atrium]] | [[Sinus venosus]] | [[Septum primum]] | [[Ostium primum]] | [[Ostium secundum]] | [[Septum secundum]] | [[Foramen ovale]] | [[Endocardial cushions]] | [[Septum intermedium]] | [[Aorticopulmonary septum]] | [[Atrial canal]]</small><br />
<br />
=BASIC SCIENCE=<br />
==[[Cardiovascular Biochemistry]]==<br />
<small>[[:Category:Molecular biology|Molecular Biology]] | [[:Category:Biochemistry|Biochemistry]] | [[:Category:Organic chemistry|Organic Chemistry]] | [[Enzymes]] | [[:Category:Immunology|Immunology]]</small><br />
<br />
=DIAGNOSTIC MODALITIES IN CARDIOLOGY=<br />
<br />
==[[The Patient History in Cardiovascular Disease]]==<br />
<small>[[Chest Pain]] | [[Claudication]] | [[Cough]] | [[Dyspnea]] | [[Orthopnea]] | [[Palpitation|Palpitations]] | [[Paroxysmal Nocturnal Dyspnea]] | [[Pedal Edema]]</small><br />
<br />
==[[The Physical Examination in Cardiovascular Disease]]==<br />
<small>[[The Physical Examination in Cardiovascular Disease: The Pulse|The Pulse]] | [[The Physical Examination in Cardiovascular Disease:The Neck|The Neck]] | [[The Physical Examination in Cardiovascular Disease:The Heart|The Heart]] | [[The Physical Examination in Cardiovascular Disease:The Lungs|Lungs]] |<br />
[[The Physical Examination in Cardiovascular Disease: The Extremities|The Extremities]]</small><br />
<br />
==[[The Electrocardiogram]]==<br />
<small>'''Intervals''' | [[PR Interval]] | [[QRS Interval]] | [[QT Interval]] | [[T Wave]] | [[The U Wave|U Wave]]</Small><br />
<br />
<small>'''Hypertrophy''' | [[Electrocardiographic Findings in LVH]] | [[Electrocardiographic Findings in Right Ventricular Hypertrophy (RVH)]] | [[Electrocardiographic Findings in Biventricular Hypertrophy|Biventricular Hypertrophy]]</small><br />
<br />
<small>'''Bundle Branch Block''' | [[Left Bundle Branch Block|LBBB]] | [[Left anterior hemiblock|LAHB]] | [[Right Bundle Branch Block|RBBB]] | [[Trifascicular block]]</small><br />
<br />
<small>'''Atrial Arrhythmias''' | [[Premature Atrial Contractions (PACs)]] | [[Ectopic Atrial Rhythm]] | [[Paroxysmal Atrial Tachycardia (PAT)]] | [[Paroxysmal Atrial Tachycardia (PAT) with Block]] | [[Multifocal Atrial Tachycardia (MAT)]] | [[Atrial flutter|Atrial Flutter]] | [[Atrial fibrillation|Atrial Fibrillation]]</small><br />
<br />
<small>'''Ventricular Arrhythmias''' | [[Differential Diagnosis of Tachycardia with a Wide QRS Complex]]<br />
| [[Accelerated Idioventricular Rhythm]] | [[Ventricular Parasystole]] | [[Ventricular Tachycardia Including Torsades De Pointes and Polymorphic Ventricular Tachycardia|Premature Ventricular Contractions]] | [[Ventricular Tachycardia Including Torsades De Pointes and Polymorphic Ventricular Tachycardia]]</small><br />
<br />
<small>'''Conduction Abnormalities''' | [[First Degree AV Block]] | [[Second Degree AV Block]] | [[Complete or Third-Degree AV Block]] | [[Concealed conduction]] | [[AV Junctional Rhythms]] | [[Wolff-Parkinson-White Syndrome]]</small><br />
<br />
<small>'''Electrocardiographic Abnormalities in Different Disease States''' | [[The EKG in the Patient with an Atrial Septal Defect (ASD)]] | [[EKG Changes of Hypothermia]] | [[EKG Abnormalities in CNS Disease]] | [[The EKG of Cardiac Transplantation]] | [[The EKG in a Patient with a Pacemaker]] | [[Electrocardiography of Traumatic Heart Disease]]</small><br />
<br />
<small>'''Drug Effects on the EKG''' | [[The EKG in the Patient Treated with Digitalis|Digitalis]] | [[The EKG in the Patient Treated with Quinidine|Quinidine]] | [[The EKG in the Patient Treated with Procainamide|Procainamide]] | [[The EKG in the Patient Treated with Disopyramide|Disopyramide]] | [[The EKG in the Patient Treated with Lidocaine|Lidocaine]] | [[The EKG in the Patient Treated with Tocainide|Tocainide and Mexiletine]] | [[The EKG in the Patient Treated with Phenytoin|Phenytoin]] | [[The EKG in the Patient Treated with Encainide, Flecainide and Propafenone|Encainide, Flecainide and Propafenone]] | [[The EKG in the Patient Treated with Beta Blockers|β-blockers]] | [[The EKG in the Patient Treated with Amiodarone|Amiodarone]] | [[The EKG in the Patient Treated with Bretylium|Bretylium]] | [[The EKG in the Patient Treated with Ca Channel Blockers|Ca Channel Blockers]] | [[The EKG in the Patient Treated with Adenosine|Adenosine]] | [[The EKG in the Patient Treated with Phenothiazines|Phenothiazines]] | [[The EKG in the Patient Treated with Tricyclic Antidepressants|Tricyclic Antidepressants]] | [[The EKG in the Patient Treated with Lithium|Lithium]]</small><br />
<br />
<small>'''EKG in Electrolyte Disturbances''' | [[The EKG in Hyperkalemia]] | [[The EKG in Hypokalemia]] | [[The EKG in Hypercalcemia]] | [[The EKG in Hypocalcemia]] | [[Nonspecific ST-Segment and T-Wave Changes]]</small><br />
<br />
==[[Exercise Stress Testing]]==<br />
<br />
==[[Cardiac Electrophysiology]]==<br />
<br />
==[[The WikiDoc Living Textbook of Biomarkers|Cardiac Biomarkers]]==<br />
<small>[[Creatine Kinase]] | [[Cytokines and their receptors]] | [[Lipoprotein-associated phospholipase A2 (Lp-PLA2)]] | [[Metalloproteinases (MMPs)]] | [[Natriuretic peptides]] | [[Prothrombin fragment 1.2 (F1.2)]] | [[Prothrombin time (PT)]] | [[Soluble CD40 ligand (sCD40L)]] | [[Thrombus precursor protein (TpP)]] | [[Von Willebrand factor (vWF)]] | [[White blood cell (WBC) count]]</small><br />
<br />
==[[Cardiac Imaging|An Overview of Cardiac Imaging]]==<br />
<br />
==[[The Chest X Ray in Cardiovascular Disease]]==<br />
<br />
==[[Echocardiography]]==<br />
<br />
==[[Nuclear Cardiology]]==<br />
<br />
==[[Coronary Angiography]]==<br />
<br />
==[[Cardiovascular Magnetic Resonance Imaging (CMR)]]==<br />
<br />
==[[CT Angiography]]==<br />
<br />
==[[Positron Emission Tomography]]==<br />
<br><br />
<br />
=CARDIAC DISEASE STATES=<br />
<br />
==[[The Genetic Basis of Heart Disease]]==<br />
<br />
==[[Congenital Heart Disease]]==<br />
Click on Show on the right to expand:<br />
{{Congenital malformations and deformations of circulatory system}}<br />
<br />
==[[Cardiac Disease in Pregnancy]]==<br />
<br />
==[[Cardiac Diseases in AIDS]]==<br />
<br />
==[[Diseases of the Pericardium]]==<br />
<br />
==[[Trauma and the Heart]]==<br />
<small>[[Commotio cordis]] </small><br />
<br />
==[[Diseases of the Valvular Structures]]==<br />
<br />
<small> [[Aortic Stenosis]] | [[Aortic Regurgitation]] | [[Mitral Stenosis]] | [[Mitral Regurgitation]] | [[Mitral Valve Prolapse]] | [[Pulmonic Regurgitation]] | [[Pulmonic Stenosis]] | [[Tricuspid Prolapse|Tricuspid Valve Prolapse]] | [[Tricuspid Regurgitation]] | [[Tricuspid Stenosis]] | [[Infective Endocarditis]]</small><br />
<br />
==[[Diseases of the Myocardium]]==<br />
<small>[[Cardiomegaly]] | [[Cardiomyopathy]] | [[Congestive Heart Failure]] | [[Left Ventricular Hypertrophy]] | [[Myocarditis]]</small><br />
<br />
==[[Cardiac Electrophysiology|Cardiac Arrhythmias]]==<br />
<br><br />
<br />
=VASCULAR MEDICINE=<br />
==[[Vascular Medicine]]==<br />
<br />
==[[Diseases of the Aorta]]==<br />
<br />
==[[Peripheral Arterial Disease]]==<br />
<br />
==[[Sytemic Arterial Hypertension]]==<br />
<br />
==[[Hypotension]]==<br />
<br />
==[[Primary Cardiac Tumors]]==<br />
<br />
==[[The Heart in Oncologic Disease]]==<br />
<br />
==[[Endocrine Disease and the Heart]]==<br />
<small>[[Endocrine Disease and the Heart#Hyperthyroidism|Hyperthyroidism]] | [[Endocrine Disease and the Heart#Hypothyroidism|Hypothyroidism]] | [[Endocrine Disease and the Heart#Hypoparathyroidism and the heart|Hypoparathyroidism]] | [[Endocrine Disease and the Heart#Acromegalic cardiomyopathy|Acromegaly]]</small><br />
<br />
==[[Renal Disease and the Heart]]==<br />
<br />
==[[Infectious Disease and the Heart]]==<br />
<small>[[Cardiac Diseases in AIDS|AIDS]] | [[The Heart in Chagas' disease|Chagas']]</small><br />
<br />
==[[Autoimmune Disease and the Heart|Autoimmune/Rheumatologic Disease and the Heart]]==<br />
<small>[[The Heart in Ankylosing Spondylitis|Ankylosing Spondylitis]] | [[The Heart in Antiphospholipid Syndrome|Antiphospholipid Syndrome]] | [[The Heart in Behçet's disease|Behçet]] | [[The Heart in Chagas' disease|Chagas]] | [[The Heart in Crohn's Disease|Crohn]] | [[The Heart in Essential Mixed Cryoglobulinemia|Essential Mixed Cryoglobulinemia]] | [[The Heart in Juvenile Rheumatoid Arthritis|Juvenile Idiopathic Arthritis]] | [[The Heart in Kawasaki Disease|Kawasaki]] | [[The Heart in Systemic Lupus Erythematosus (SLE)|Lupus]] | [[The Heart in Mixed Connective Tissue Disorder|Mixed Connective Tissue Disorder]] | [[The Heart in Polyarteritis Nodosa|Polyarteritis Nodosa]] | [[The Heart in Polychondritis|Polychondritis]] | [[The Heart in Polymyositis and Dermatomyositis|Polymyositis & Dermatomyositis]] | [[The Heart in Psoriasis|Psoriasis]] | [[The Heart in Rheumatoid Arthritis|Rheumatoid Arthritis]] | [[The Heart in Progressive Systemic Sclerosis (Scleroderma)|Scleroderma]] | [[The Heart in Sarcoidosis|Sarcoidosis]] | [[The Heart in Takayasu Arteritis|Takayasu]] | [[The Heart in Temporal Arteritis / Giant Cell Arteritis|Temporal Arteritis]] | [[The Heart in Ulcerative colitis|Ulcerative Colitis]] | [[The Heart in Wegener's Granulomatosis| Wegener's Granulomatosis]] | [[The Heart in Wilson's Disease|Wilson]]</small><br />
<br />
==[[Pulmonary Embolism]]==<br />
<br />
==[[Pulmonary Hypertension]]==<br />
<br />
==[[Cor Pulmonale]]==<br />
<br />
==[[Pre-Operative Clearance]]==<br />
<br><br />
<br />
=HEMOCARDIOLOGY=<br />
<br />
==[[The Role of the Coagulation System in Heart Disease]]==<br />
<br><br />
<br />
=CORONARY ARTERY DISEASE=<br />
<br />
==[[Atherosclerosis Prevention and Risk Factor Modification]]==<br />
<br />
==[[Chronic Stable Angina]]==<br />
<small>[[Chronic Stable Angina Introduction|Introduction]] | [[Chronic Stable Angina Definition|Definition]] | [[Chronic Stable Angina Historical Perspective|Historical Perspective]] | [[Chronic Stable Angina Epidemiology|Epidemiology]] | [[Chronic Stable Angina Pathophysiology|Pathophysiology]] | [[Chronic Stable Angina Clinical Presentation|Presentation]] | [[Chronic Stable Angina Recognition of Clinical Subsets|Recognition of Clinical Subsets]] | [[Chronic Stable Angina Recognition and Evaluation of Risk Factors|Risk Factors]] | [[Chronic Stable Angina Diagnosis|Diagnosis]] | [[Chest Pain|Differential Diagnosis of Chest Pain]] | [[Chronic Stable Angina Treatment|Treatment]] | [[Chronic Stable Angina Prognosis|Prognosis]] | [[Chronic Stable Angina Rehabilitation|Rehabilitation]] | [[Chronic Stable Angina Secondary Prevention|Prevention]]</small><br />
<br />
==[[Unstable Angina]]==<br />
<br />
==[[Non ST Elevation Myocardial Infarction]]==<br />
<br />
==[[ST Elevation Myocardial Infarction]]==<br />
<br />
<small>[[ST Elevation Myocardial Infarction Overview|Overview]] | [[ST Elevation Myocardial Infarction: Epidemiology and Demographics | Epidemiology and Demographics]] | [[ST Elevation Myocardial Infarction: Pathophysiology of Reperfusion |Pathophysiology of Reperfusion]] | [[ST Elevation Myocardial Infarction Risk Factors|Risk Factors]] | [[ST Elevation Myocardial Infarction Pathophysiology|Pathophysiology]] | [[ST Elevation Myocardial Infarction Triggers|Triggers]] | [[ST Elevation Myocardial Infarction Classification|Classification]]</small><br />
<br />
<small>[[ST Elevation Myocardial Infarction Diagnosis|Diagnosis]] | [[ST Elevation Myocardial Infarction Symptoms|Symptoms]] | [[ST Elevation Myocardial Infarction Physical Examination|Physical Examination]] | [[ST Elevation Myocardial Infarction Electrocardiogram|Electrocardiogram]] | [[ST Elevation Myocardial Infarction Cardiac Markers|Cardiac Markers]] | [[ST Elevation Myocardial Infarction Coronary Angiography|Coronary Angiography]] | [[ST Elevation Myocardial Infarction Histopathology|Histopathology]] </small><br />
<br />
<small>[[Treatment]] | [[ST Elevation Myocardial Infarction Pre-Hospital Care|Pre-Hospital Care]] | [[ST Elevation Myocardial Infarction Initial Care|Initial Care]] | [[ST Elevation Myocardial Infarction Thrombolytic Therapy|Thrombolytic Therapy]] | [[ST Elevation Myocardial Infarction Primary Percutaneous Coronary Intervention|Primary Percutaneous Coronary Intervention]] | [[ST Elevation Myocardial Infarction Rescue Percutaneous Coronary Intervention|Rescue Percutaneous Coronary Intervention]] | [[ST Elevation Myocardial Infarction Facilitated Percutaneous Coronary Intervention|Facilitated Percutaneous Coronary Intervention]] | [[ST Elevation Myocardial Infarction Coronary Artery Bypass Graft Surgery|Coronary Artery Bypass Graft Surgery]] | [[Barriers to Implementing Clinical Guidelines]]</small><br />
<br />
<small>[[ST Elevation Myocardial Infarction Arrhythmia Monitoring]] | [[ST Elevation Myocardial Infarction Secondary Prevention|Secondary Prevention]] | [[ST Elevation Myocardial Infarction Complications|Complications]] | [[ST Elevation Myocardial Infarction Prognosis|Prognosis]] | <br />
[[ST Elevation Myocardial Infarction]] | [[Cardiac Rehabilitation]]</small><br />
<br />
==[[The Living Guidelines]]==<br />
<br><br />
<br />
=PHARMACOTHERAPY=<br />
==[[:Category:Cardiovascular_Drugs|Cardiovascular Pharmacotherapy]]==<br />
===Adrenergic Agonists===<br />
<Small>'''Adrenergic Agonists [[Adrenergic agonist|Overview]]'''</small><br />
<br />
<small>'''Direct Acting''' | [[Dobutamine]] | [[Dopamine]] | [[Epinephrine]] | [[Formoterol]] | [[Isoproterenol]] | [[Metaproterenol]] | [[Methoxamine]] | [[Norepinephrine]] | [[Phenylephrine]] | [[Salmeterol]] | [[Tamsulosin]] | [[Terbutaline]]</small><br />
<br />
<small>'''Indirect Acting''' | [[Amphetamine]] | [[Tyramine]] </small><br />
<br />
<small>'''Mixed Action''' | [[Ephedrine]]</small><br />
----<br />
===Angiotensin-Renin Inhibitors ([[ATC code C09|C09]])===<br />
<br />
<small>'''ACE Inhibitor [[ACE inhibitor|Overview]]''' | [[Benazepril]] | [[Captopril]] | [[Enalapril]] | [[Fosinopril]] | [[Lisinopril]] | [[Perindopril]] | [[Quinapril]] | [[Ramipril]] | [[Spirapril]] | [[Trandolapril]]</small><br />
<br />
<small>'''Angiotensin II receptor antagonist [[Angiotensin II receptor antagonist|Overview]]''' | [[Candesartan]] | [[Eprosartan]] | [[Irbesartan]] | [[Losartan]] | [[Olmesartan]] | [[Tasosartan]] | [[Telmisartan]] | [[Valsartan]]</small><br />
<br />
<small>'''Renin Inhibitors [[Renin inhibitor|Overview]]''' | [[Aliskiren]] | [[Remikiren]]</small><br />
----<br />
===Antiarrhythmic agents===<br />
<small>'''Antiarrhythmic Agents [[Antiarrhythmic agent|Overview]]''' ([[ATC code C01#C01B Antiarrhythmics, class I and III|C01B]])</small><br />
<br />
<small>'''Class Ia''' | [[Ajmaline]] | [[Disopyramide]] | [[Prajmaline]] | [[Procainamide]] | [[Quinidine]] | [[Sparteine]]</small><br />
<br />
<small>'''Class Ib''' | [[Aprindine]] | [[Lidocaine]] | [[Mexiletine]] | [[Tocainide]]</small><br />
<br />
<small>'''Class Ic''' | [[Encainide]] | [[Flecainide]] | [[Lorcainide]] | [[Moricizine]] | [[Propafenone]] </small><br />
<br />
<small>'''Class II''' | [[Propranolol]] | [[Metoprolol]] | [[Nadolol]] | [[Atenolol]] | [[Acebutolol]] | [[Pindolol]] see [[Beta blockers]] ([[ATC code C07|C07]])</small><br />
<br />
<small>'''Class III''' | [[Amiodarone]] | [[Bretylium|Bretylium tosylate]] | [[Bunaftine]] | [[Dofetilide]] | [[Ibutilide]] | [[Sotalol]]</small><br />
<br />
<small>'''Class IV''' | [[Verapamil]] | [[Diltiazem]] see [[Calcium channel blocker]]s ([[ATC code C08|C08]])</small><br />
<br />
<small>'''Class V''' | [[Adenosine]] | [[Atropine]] | [[Digoxin]]</small><br />
----<br />
===Anticoagulants===<br />
<small>'''Anticoagulants [[Anticoagulant|Overview]]'''</small><br />
<br />
<small>'''Vitamin K Antagonists [[Vitamin K|Overview]]''' | [[Acenocoumarol]] | [[Clorindione]] | [[Coumatetralyl]] | [[Dicumarol]] (Dicoumarol) | [[Diphenadione]] | [[Ethyl biscoumacetate]] | [[Phenprocoumon]] | [[Phenindione]] | [[Tioclomarol]] | [[Warfarin]]</small><br />
----<br />
=== Antihypertensives and Diuretics===<br />
<small>'''Antihypertensive [[Antihypertensive|Overview]]''' ([[ATC code C02|C02]]) and '''Diuretic [[Diuretic|Overview]]''' ([[ATC code C03|C03]])</small><br />
<br />
<small>'''Sympatholytic Agents [[Sympatholytic|Overview]] (including Alpha Blockers [[Alpha blocker|Overview]])'''</small><br />
<br />
:<small>'''Centrally Acting Antiadrenergics [[antiadrenergic|Overview]]''' | [[Clonidine]] | [[Guanfacine]] | [[Methyldopa]] | [[Moxonidine]] | [[Rescinnamine]] | [[Reserpine]] | [[Rilmenidine]] </small><br />
<br />
:<small>'''Ganglionic Blocker [[Ganglionic blocker|Overview]] / Nicotinic Antagonist [[Nicotinic antagonist|Overview]]''' | [[Mecamylamine]] | [[Trimethaphan]]</small><br />
<br />
:<small>'''Peripherally acting/Antiadrenergics''' | [[Prazosin]] | [[Guanethidine]] | [[Indoramin]] | [[Doxazosin]]</small><br />
<br />
<small>'''Vasodilators [[Vasodilator|Overview]]''' | [[Diazoxide]] | [[Hydralazine]] | [[Minoxidil]] | [[Sodium nitroprusside|Nitroprusside]] | [[Phentolamine]]</small><br />
<br />
<small>'''Other antihypertensives''' </small><br />
<br />
:<small>'''Serotonin Antagonist [[Serotonin antagonist|Overview]]''' |[[Ketanserin]] </small><br />
<br />
:<small>'''Endothelin Receptor Antagonist [[Endothelin receptor antagonist|Overview]]''' | [[Bosentan]] | [[Ambrisentan]] | [[Sitaxsentan]] </small><br />
<br />
<small>'''Low ceiling diuretics''' </small><br />
<br />
:<small>'''Thiazide [[Thiazide|Overview]]''' | [[Bendroflumethiazide]] | [[Chlorothiazide]] | [[Hydrochlorothiazide]] </small><br />
<br />
:<small>'''Non-thiazides''' | [[Chlortalidone]] | [[Indapamide]] | [[Quinethazone]] | [[Mersalyl]] | [[Metolazone]] | [[Theobromine]] | [[Cicletanine]]</small><br />
<br />
<small>'''High ceiling diuretics'''</small><br />
<br />
:<small>'''Loop Diuretic [[Loop diuretic|Overview]]''' | [[Bumetanide]] | [[Furosemide]] | [[Torasemide]])</small><br />
<br />
:<small>'''Potassium-Sparing Diuretics [[Potassium-sparing diuretic|Overview]]'''</small><br />
<br />
:<small>'''Epithelial Sodium Channel [[Epithelial sodium channel|Overview]]''' |[[Amiloride]] | [[Triamterene]])</small><br />
<br />
:<small>'''Aldosterone Antagonist [[Aldosterone antagonist|Overview]]''' |[[Spironolactone]] | [[Eplerenone]] | [[Potassium canrenoate]] | [[Canrenone]]</small><br />
----<br />
===Antiplatelet Agents===<br />
<small>'''Glycoprotein IIb/IIIa Inhibitors [[Glycoprotein IIb/IIIa inhibitors|Overview]]''' | [[Abciximab]] | [[Eptifibatide]] | [[Tirofiban]]</small><br />
<br />
<small>'''ADP Receptor Antagonists''' | [[Clopidogrel]] | [[Ticlopidine]] | [[Prasugrel]] </small><br />
<br />
<small>'''Prostaglandin Analogues [[prostaglandin analogue|Overview]]''' | [[Beraprost]] | [[Prostacyclin]] | [[Iloprost]] | [[Treprostinil]]</small><br />
<br />
<small>'''Other Antiplatelet Agents''' [[Acetylsalicylic acid|Acetylsalicylic acid/Aspirin]] | [[Aloxiprin]] | [[Ditazole]] | [[Carbasalate calcium]] | [[Cloricromen]] | [[Dipyridamole]] | [[Indobufen]] | [[Picotamide]] | [[Triflusal]] </small><br />
<br />
----<br />
===Antithrombins===<br />
<small>'''Direct Thrombin Inhibitors [[Direct thrombin inhibitor|Overview]]''' | [[Argatroban]] | [[Bivalirudin]] | [[Dabigatran]] | [[Desirudin]] | [[Hirudin]] | [[Lepirudin]] | [[Melagatran]] | [[Ximelagatran]]</small><br />
<br />
<small>'''Indirect Thrombin Inhibitors '''</small><br />
:<small>'''Heparins''' | [[Danaparoid]] | [[Heparin]] | [[Sulodexide]]</small> <br />
:<small>'''Low Molecular Weight Heparins''' | [[Bemiparin]] | [[Dalteparin]] | [[Enoxaparin]] | [[Nadroparin]] | [[Parnaparin]] | [[Reviparin]] | [[Tinzaparin]]</small><br />
<br />
<small>'''Other Antithrombotics''' | [[Defibrotide]] | [[Dermatan sulfate]] | [[Fondaparinux]] | [[Rivaroxaban]]</small><br />
<br />
<small>'''Non-Medicinal Antithrombins [[Anticoagulant#Anticoagulants outside the body|Overview]]''' | [[Citrate]] | [[EDTA]] | [[Oxalate]]</small><br />
----<br />
===Beta Blockers===<br />
<small>'''Beta Blockers [[Beta blocker|Overview]]''' [[ATC code C07|(C07)]]</small><br />
<br />
<small>'''Non-selective β antagonists''' | [[Metipranolol]] | [[Nadolol]] | [[Oxprenolol]] | [[Penbutolol]] | [[Pindolol]] | [[Propranolol]] | [[Timolol]] | [[Sotalol]]</small><br />
<br />
<small>'''β<sub>1</sub> antagonists (cardioselective)''' | [[Atenolol]] | [[Acebutolol]] | [[Betaxolol]] | [[Bisoprolol]] | [[Esmolol]] | [[Metoprolol]] | [[Nebivolol]]</small><br />
<br />
<small>'''Mixed α<sub>1</sub>/β antagonists''' | [[Carvedilol]] | [[Labetalol]]</small><br />
----<br />
===Calcium Channel Blockers===<br />
<small>'''Calcium Channel Blocker [[Calcium channel blocker|Overview]]'''</small><br />
<br />
<small>'''Class I''' Phenylalkylamines ([[ATC code C08#C08DA_Phenylalkylamine_derivatives|C08DA]]) | [[Verapamil]]</small><br />
<br />
<small>'''Class II''' Dihydropyridines ([[ATC code C08#C08CA_Dihydropyridine_derivatives|C08CA]]) <br />
| [[Amlodipine]] | [[Felodipine]] | [[Isradipine]] | [[Lacidipine]] | [[Lercanidipine]] | [[Nicardipine]] | [[Nifedipine]] | [[Nimodipine]] | [[Nisoldipine]]</small><br />
<br />
<small>'''Class III''' Benzothiazepines ([[ATC code C08#C08DB_Benzothiazepine_derivatives|C08DB]])<br />
| [[Diltiazem]]</small><br />
----<br />
<br />
===Cardiac Glycosides===<br />
<small>'''Cardiac Glycoside [[Cardiac glycoside|Overview]]''' ([[ATC_code_C01#C01A_Cardiac_glycosides|C01A]])</small><br />
<br />
<small>'''Digitalis Glycosides [[Digitalis|Overview]]''' | [[Acetyldigitoxin]] | [[Acetyldigoxin]] | [[Digitalis]] leaves | [[Digitoxin]] | [[Digoxin]] | [[Lanatoside C]] | [[Deslanoside]] | [[Medigoxin|Metildigoxin]] | [[Gitoformate]]</small><br />
<br />
<small>'''Scilla Glycosides [[Scilla|Overview]]''' | [[Proscillaridin]]</small><br />
<br />
<small>'''Strophantus Glycosides [[Strophantus|Overview]]''' | [[Ouabain|G-strophanthin]] | [[Cymarin]]</small><br />
<br />
<small>'''Other Cardiac Glycosides''' | [[Peruvoside]]</small><br />
----<br />
=== Cardiac Stimulants Excluding Cardiac Glycosides===<br />
'''Cardiac stimulants excluding cardiac glycosides''' ([[ATC_code_C01#C01C_Cardiac_stimulants_excluding_cardiac_glycosides|C01C]])<br />
<br />
'''Adrenergic [[adrenalin|Overview]] and Dopaminergic [[dopaminergic|Overview]] agents''' |<br />
[[Etilefrine]] | [[Isoproterenol|Isoprenaline]] | [[Norepinephrine]] | [[Dopamine]] | [[Norfenefrine]] | [[Phenylephrine]] | [[Dobutamine]] | [[Synephrine|Oxedrine]] | [[Metaraminol]] | [[Methoxamine]] | [[Mephentermine]] | [[Dimetofrine]] | [[Prenalterol]] | [[Dopexamine]] | [[Gepefrine]] | [[Ibopamine]] | [[Midodrine]] | [[Octopamine]] | [[Fenoldopam]] | [[Cafedrine]] | [[Arbutamine]] | [[Theodrenaline]] | [[Epinephrine]]<br />
<br />
'''Phosphodiesterase Inhibitors [[Phosphodiesterase inhibitor|Overview]] ([[PDE3 inhibitor|PDE3I]])''' | [[Amrinone]] | [[Milrinone]] | [[Enoximone]] | [[Bucladesine]]<br />
<br />
'''Other cardiac stimulants''' | [[Angiotensinamide]] | [[Xamoterol]] | [[Levosimendan]]<br />
<br />
----<br />
===Fibrinolytics===<br />
<small>[[Tissue plasminogen activator|Alteplase]] | [[Reteplase]] | [[Tenecteplase]] | [[Streptokinase]], [[Urokinase]] | [[Saruplase]] | [[Anistreplase]]</small><br />
----<br />
===Hypolipidemic Agents===<br />
<br />
<small>'''Statins [[Statins|Overview]]''' | [[Atorvastatin]] | [[Cerivastatin]] | [[Fluvastatin]] | [[Lovastatin]] | [[Mevastatin]] | [[Pitavastatin]] | [[Pravastatin]] | [[Rosuvastatin]] | [[Simvastatin]] </small><br />
<br />
<small>'''Fibrates [[Fibrate|Overview]]''' | [[Clofibrate]] | [[Bezafibrate]] | [[Aluminium clofibrate]] | [[Gemfibrozil]] | [[Fenofibrate]] | [[Simfibrate]] | [[Ronifibrate]] | [[Ciprofibrate]] | [[Etofibrate]] | [[Clofibride]]</small><br />
<br />
<small>'''Bile Acid Sequestrant [[Bile acid sequestrant|Overview]]''' | [[Cholestyramine|Colestyramine]] | [[Colestipol]] | [[Colextran]] | [[Colesevelam]]</small><br />
<br />
<small>'''Niacin and Derivatives''' | [[Niceritrol]] | [[Niacin]] | [[Nicofuranose]] | [[Aluminium nicotinate]] | [[Nicotinyl alcohol]] | [[Acipimox]]</small><br />
<br />
<small>'''Other''' | [[Dextrothyroxine]] | [[Probucol]] | [[Tiadenol]] | [[Benfluorex]] | [[Meglutol]] | [[Omega-3-triglycerides]] | [[Magnesium pyridoxal 5-phosphate glutamate]] | [[Policosanol]] | [[Ezetimibe]]</small><br />
----<br />
===Nitrates===<br />
<small>'''Nitrates [[Nitrate|Overview]]''' | [[Glyceryl trinitrate (pharmacology)|Glyceryl trinitrate]] | [[Isosorbide dinitrate]] | [[Isosorbide mononitrate]] | [[Molsidomine]] | [[PETN|Pentaerythritol tetranitrate]]</small><br />
----<br />
===Pulmonary Artery Hypertension===<br />
<small>Medications used in the management of pulmonary arterial hypertension [[pulmonary hypertension|Overview]] ([[ATC code B01|B01]], [[ATC code C02|C02]])</small><br />
<br />
<small>'''Prostacyclin [[Prostacyclin|Overview]]''' | [[Beraprost]] | [[Epoprostenol]] | [[Iloprost]] | [[Treprostinil]]</small><br />
<br />
<small>'''Endothelin Receptor Antagonists [[Endothelin receptor antagonist|Overview]]''' | [[Ambrisentan]] | [[Bosentan]] | [[Sitaxsentan]]</small><br />
<br />
<small>'''PDE5 Inhibitors [[PDE5 inhibitor|Overview]]''' | [[Sildenafil]] | [[Tadalafil]] | [[Vardenafil]]</small><br />
<br />
<small>'''Adjunctive therapy''' | [[Calcium channel blocker]]s | [[Diuretic]]s | [[Digoxin]] | [[Oxygen therapy]] | [[Warfarin]]</small><br />
----<br />
===Vasodilators===<br />
<br />
<small>'''Vasodilators [[Vasodilator|Overview]] ([[ATC_code_C01#C01D_Vasodilators_used_in_cardiac_diseases|C01D]]) </small><br />
<br />
<small>'''Quinolone Vasodilators [[Quinolone|Overview]]''' | [[Flosequinan]]</small><br />
<br />
<small>'''Other Vasodilators''' | [[Heptaminol]] | [[Molsidomine]] | [[Nicorandil]] | [[Nesiritide]]</small><br />
----<br />
<br><br />
<br />
=INTERVENTIONAL CARDIOLOGY=<br />
==[[Interventional Cardiology]]==<br />
<small>'''Diagnostic Catheterization''' | [[Risk Stratification and the Benefits of PCI vs Medical Therapy]] | [[Conscious Sedation]] | [[Preparation of the Patient for Diagnostic Catheterization]] | [[Technical Aspects of the Cardiac Catheterization Laboratory]] | [[Obtaining Venous and Arterial Access]] | [[Equipment Used in Diagnostic Cardiac Catheterizaiton]] | [[Hemodynamic Assessment in the Cardiac Catheterization Laboratory]] | [[Radiation Safety]]</small><br />
<br />
<small>'''Assesement of coronary lesions''' | [[Coronary Fractional Flow Reserve (FFR)]]) | [[Coronary flow reserve]]([[CFR]]) | [[Intravascular ultrasound]] ([[IVUS]])</small><br />
<br />
<small>'''PCI''' | [[Preparation of the Patient for Percutaneous Coronary Intervention (PCI)]] | [[Percutaneous Coronary Intervention (PCI): Basic Principles and Guidelines]] | [[Equipment Used in Percutaneous Coronary Intervention]] | [[Pharmacotherapy to Support PCI]] | [[Antiplatelet therapy]] | [[Antithrombotic therapy]] | [[Angiography and PCI in Special Patient Populations]] | [[Management Of Specific Lesion Types]] | [[High Risk Percutaneous Coronary Intervention (PCI)]] | [[Vascular Closure Devices]] | [[Post PCI Medical Management of the Interventional Patient]] | [[Complications During and Following Cardiac Catheterization and Percutaneous Coronary Intervention]] | [[Coronary stent thrombosis]]<br />
<br />
'''PCI in Specific Populations and Lesion Types'''<br />
*[[Assessment of Lesion Complexity and Morphology Using Coronary Lesion Classification Systems]]<br />
*[[PCI in the Patient with Angiographically Visible Thrombus|Angiographically Visible Thrombus]]<br />
*[[PCI in the Calcified Lesion|The Calcified Leison]]<br />
*[[PCI in the Ostial Lesion|The Ostial Lesion]]<br />
*[[PCI in the Angulated or Tortuous Lesion|The Angulated or Tortuous Lesion]]<br />
*[[PCI in the Bifurcation Lesion|Management of the Bifurcation Lesion]]<br />
*[[PCI in the Long Lesion|The Long Lesion]]<br />
*[[Myocardial bridge|Management of a Coronary Bridge Lesion and Kinks]]<br />
*[[PCI in the Patient with Coronary Vasospasm|Management of Coronary Vasospasm]]<br />
*[[PCI in the Patient with a Chronic Total Occlusion|The Chronic Total Occlusion (CTO)]]<br />
*[[PCI in Small Vessels|Intervention in Small Vessels]]<br />
*[[PCI in Diffusely Diseased Vessels|Intervention in Diffusely Diseased Vessels]]<br />
*[[Intervention in Saphenous Vein Grafts (SVG)|Intervention in Saphenous Vein Grafts (SVG)]]<br />
*[[PCI in the Left Internal Mammary Artery|Intervention in the LIMA]]<br />
*[[PCI in the Right Internal Mammary Artery|Intervention in the RIMA]]<br />
*[[PCI in a Free Radial Artery or Other Conduit|Intervention in a Free Radial and other Conduits]]<br />
*[[Multivessel PCI|Multivessel Intervention]]<br />
*[[PCI in the Patient with Restenosis|PCI in the Patient with Restenosis]]<br />
*[[Stent Thrombosis|Management of the Patient with Stent Thrombosis]]<br />
*[[Treatment of Distal Anastomotic Lesions|Treatment of Distal Anastomotic Lesions]]<br />
*[[Coronary Artery Perforation|Coronary Artery Perforation]]<br />
*[[Left Main Intervention|Left Main Intervention]]<br />
*[[Management of the Thrombotic Lesion|Management of the Thrombotic Lesion]]<br />
<br />
</small><br />
<br />
<small>'''High Risk PCI''' | [[PCI in the Patient in Cardiogenic Shock|PCI in the Patient in Cardiogenic Shock]] | [[PCI in the Patient Requiring CPR and Refractory Ventricular Arrhythmias|PCI in the Patient Requiring CPR and Refractory Ventricular Arrhythmias]] | [[PCI in the Patient with Severely Depressed Ventricular Function|PCI in the Patient with Severely Depressed Ventricular Function]] | [[PCI in the Patient with Critical Valve Stenosis|PCI in the Patient with Critical Valve Stenosis]] | [[PCI in the Sole Remaining Conduit|PCI in the Sole Remaining Conduit]] | [[PCI in the Unprotected Left Main Patient|PCI in the Unprotected Left Main Patient]] | [[Adjuncts for High Risk Percuatenous Coronary Intervention|Adjuncts for High Risk Percuatenous Coronary Intervention]]</small><br />
<br />
<small>'''Mechanical circulatory support''' | [[Mechanical circulatory support]] | [[Intra-aortic balloon pump]] | [[Ventricular assist device|Ventricular assist devices]]<br />
<br />
[[Artificial heart]]<br />
<br />
<small>'''Other Topics'''[[Non Coronary Interventions in the Cardiac Catheterization Laboratory]] | [[Transfusion in ACS management]] | [[Revascularization in the "No Option" Patient]]</small><br />
<br><br />
<br />
=Cardiac Surgery=<br />
{{Cardiac surgery}}<br />
<br />
=Vascular Surgery=<br />
{{Vascular surgery}}<br />
=BIOSTATISTICS=<br />
==[[Biostatistics Home Page|Biostatistics]]==<br />
<br><br />
<br />
=COST EFFECTIVENESS AND QUALITY OF LIFE=<br />
==[[Cost Effectiveness in Cardiovascular Disease]]==<br />
<br />
{{WH}}<br />
{{WikiDoc Sources}}</div>
Ifeoma odukwe
https://www.wikidoc.org/index.php?title=Sandbox:_zaida&diff=1609571
Sandbox: zaida
2020-05-26T17:57:58Z
<p>Ifeoma odukwe: /* Complications */</p>
<hr />
<div>==Hypertension==<br />
===Types===<br />
There are two types of Hypertension:<ref name="pmid518773">{{cite journal| author=Calcaterra G, Anderson RH, Lau KC, Shinebourne EA| title=Dextrocardia--value of segmental analysis in its categorisation. | journal=Br Heart J | year= 1979 | volume= 42 | issue= 5 | pages= 497-507 | pmid=518773 | doi=10.1136/hrt.42.5.497 | pmc=482192 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=518773 }} </ref><br />
<br />
'''Primary''': not related to another medical condition<br />
<br />
'''Secodary''': Another medical condition that causes high blood pressure, including:<br />
*[[Kidney]] disease<br />
* Adrenal disease<br />
*[[Hyperparathyroidism]]<br />
*[[Thyroid]] problems<br />
*[[Aortic coarctation|Coarctation of Aorta]]<br />
* Obstructive sleep apnea<br />
<br />
===Symptoms===<br />
High blood pressure often has no symptoms, if it's extremely high it might causes symptoms like:<br />
* Sever [[headache]]<br />
*[[Fatigue]] or confusion<br />
* Blurry vision<br />
*[[Chest pain]]<br />
*[[Dyspnea]]<br />
* Irregular heartbeat<br />
* Bloody urine<br />
* Pounding sensation in the patient's chest, neck, or ears<br />
<br />
===Risk Factors===<br />
High blood pressure has many risk factors, including:<br />
* Age<br />
* Race<br />
* Family history <br />
* Overweight and obesity <br />
* Tobacco<br />
* High sodium or low potassium diet <br />
* Diabetes <br />
* Lack of physical activity <br />
* Stress<br />
<br />
===Complications===<br />
Uncontrolled Hypertension can cause serious problems, such as:<ref name="ArunabhaSumit2014">{{cite journal|last1=Arunabha|first1=DC|last2=Sumit|first2=RT|last3=Sourin|first3=B|last4=Sabyasachi|first4=C|last5=Subhasis|first5=M|title=Kartagener’s Syndrome: A Classical Case|journal=Ethiopian Journal of Health Sciences|volume=24|issue=4|year=2014|pages=363|issn=1029-1857|doi=10.4314/ejhs.v24i4.13}}</ref><br />
<br />
* Heart attack or stroke<br />
* Aneurysm<br />
* Heart failure <br />
* Kidney damage<br />
* Vision problems<br />
* Peripheral artery disease (PAD) <br />
* Hypertensive crisis<br />
* Sexual dysfunction</div>
Ifeoma odukwe
https://www.wikidoc.org/index.php?title=Dextrocardia_primary_prevention&diff=1609570
Dextrocardia primary prevention
2020-05-26T17:53:23Z
<p>Ifeoma odukwe: /* Overview */</p>
<hr />
<div>__NOTOC__<br />
{{Dextrocardia}}<br />
{{CMG}}; {{AE}} <br />
<br />
==Overview==<br />
There are no established measures for the primary prevention of dextrocardia.<br />
<br />
==Primary Prevention==<br />
There are no established measures for the primary prevention of dextrocardia.<br />
<br />
==References==<br />
{{Reflist|2}}<br />
<br />
{{WH}}<br />
{{WS}}</div>
Ifeoma odukwe
https://www.wikidoc.org/index.php?title=Dextrocardia_primary_prevention&diff=1609569
Dextrocardia primary prevention
2020-05-26T17:52:20Z
<p>Ifeoma odukwe: /* Primary Prevention */</p>
<hr />
<div>__NOTOC__<br />
{{Dextrocardia}}<br />
{{CMG}}; {{AE}} <br />
<br />
==Overview==<br />
There are no established measures for the primary prevention of [disease name].<br />
<br />
OR<br />
<br />
There are no available vaccines against [disease name].<br />
<br />
OR<br />
<br />
Effective measures for the primary prevention of [disease name] include [measure1], [measure2], and [measure3].<br />
<br />
OR<br />
<br />
[Vaccine name] vaccine is recommended for [patient population] to prevent [disease name]. Other primary prevention strategies include [strategy 1], [strategy 2], and [strategy 3].<br />
<br />
==Primary Prevention==<br />
There are no established measures for the primary prevention of dextrocardia.<br />
<br />
==References==<br />
{{Reflist|2}}<br />
<br />
{{WH}}<br />
{{WS}}</div>
Ifeoma odukwe
https://www.wikidoc.org/index.php?title=Dextrocardia_primary_prevention&diff=1609568
Dextrocardia primary prevention
2020-05-26T17:51:21Z
<p>Ifeoma odukwe: Created page with "__NOTOC__ {{Dextrocardia}} {{CMG}}; {{AE}} ==Overview== There are no established measures for the primary prevention of [disease name]. OR There are no available vaccines..."</p>
<hr />
<div>__NOTOC__<br />
{{Dextrocardia}}<br />
{{CMG}}; {{AE}} <br />
<br />
==Overview==<br />
There are no established measures for the primary prevention of [disease name].<br />
<br />
OR<br />
<br />
There are no available vaccines against [disease name].<br />
<br />
OR<br />
<br />
Effective measures for the primary prevention of [disease name] include [measure1], [measure2], and [measure3].<br />
<br />
OR<br />
<br />
[Vaccine name] vaccine is recommended for [patient population] to prevent [disease name]. Other primary prevention strategies include [strategy 1], [strategy 2], and [strategy 3].<br />
<br />
==Primary Prevention==<br />
There are no established measures for the primary prevention of [disease name].<br />
<br />
OR<br />
<br />
There are no available vaccines against [disease name].<br />
<br />
OR<br />
<br />
Effective measures for the primary prevention of [disease name] include:<br />
*[Measure1]<br />
*[Measure2]<br />
*[Measure3]<br />
<br />
OR<br />
<br />
[Vaccine name] vaccine is recommended for [patient population] to prevent [disease name]. Other primary prevention strategies include:<br />
*[Strategy 1]<br />
*[Strategy 2]<br />
*[Strategy 3]<br />
<br />
==References==<br />
{{Reflist|2}}<br />
<br />
{{WH}}<br />
{{WS}}</div>
Ifeoma odukwe
https://www.wikidoc.org/index.php?title=Sandbox:_zaida&diff=1609567
Sandbox: zaida
2020-05-26T17:47:40Z
<p>Ifeoma odukwe: /* Types */</p>
<hr />
<div>==Hypertension==<br />
===Types===<br />
There are two types of Hypertension:<ref name="pmid518773">{{cite journal| author=Calcaterra G, Anderson RH, Lau KC, Shinebourne EA| title=Dextrocardia--value of segmental analysis in its categorisation. | journal=Br Heart J | year= 1979 | volume= 42 | issue= 5 | pages= 497-507 | pmid=518773 | doi=10.1136/hrt.42.5.497 | pmc=482192 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=518773 }} </ref><br />
<br />
'''Primary''': not related to another medical condition<br />
<br />
'''Secodary''': Another medical condition that causes high blood pressure, including:<br />
*[[Kidney]] disease<br />
* Adrenal disease<br />
*[[Hyperparathyroidism]]<br />
*[[Thyroid]] problems<br />
*[[Aortic coarctation|Coarctation of Aorta]]<br />
* Obstructive sleep apnea<br />
<br />
===Symptoms===<br />
High blood pressure often has no symptoms, if it's extremely high it might causes symptoms like:<br />
* Sever [[headache]]<br />
*[[Fatigue]] or confusion<br />
* Blurry vision<br />
*[[Chest pain]]<br />
*[[Dyspnea]]<br />
* Irregular heartbeat<br />
* Bloody urine<br />
* Pounding sensation in the patient's chest, neck, or ears<br />
<br />
===Risk Factors===<br />
High blood pressure has many risk factors, including:<br />
* Age<br />
* Race<br />
* Family history <br />
* Overweight and obesity <br />
* Tobacco<br />
* High sodium or low potassium diet <br />
* Diabetes <br />
* Lack of physical activity <br />
* Stress<br />
<br />
===Complications===<br />
Uncontrolled Hypertension can cause serious problems, such as:<br />
* Heart attack or stroke<br />
* Aneurysm<br />
* Heart failure <br />
* Kidney damage<br />
* Vision problems<br />
* Peripheral artery disease (PAD) <br />
* Hypertensive crisis<br />
* Sexual dysfunction</div>
Ifeoma odukwe
https://www.wikidoc.org/index.php?title=Sandbox:_zaida&diff=1609566
Sandbox: zaida
2020-05-26T17:39:18Z
<p>Ifeoma odukwe: /* Types */</p>
<hr />
<div>==Hypertension==<br />
===Types===<br />
There are two types of Hypertension:<br />
<br />
'''Primary''': not related to another medical condition<br />
<br />
'''Secodary''': Another medical condition that causes high blood pressure, including:<br />
*[[Kidney]] disease<br />
* Adrenal disease<br />
*[[Hyperparathyroidism]]<br />
*[[Thyroid]] problems<br />
*[[Aortic coarctation|Coarctation of Aorta]]<br />
* Obstructive sleep apnea<br />
<br />
===Symptoms===<br />
High blood pressure often has no symptoms, if it's extremely high it might causes symptoms like:<br />
* Sever [[headache]]<br />
*[[Fatigue]] or confusion<br />
* Blurry vision<br />
*[[Chest pain]]<br />
*[[Dyspnea]]<br />
* Irregular heartbeat<br />
* Bloody urine<br />
* Pounding sensation in the patient's chest, neck, or ears<br />
<br />
===Risk Factors===<br />
High blood pressure has many risk factors, including:<br />
* Age<br />
* Race<br />
* Family history <br />
* Overweight and obesity <br />
* Tobacco<br />
* High sodium or low potassium diet <br />
* Diabetes <br />
* Lack of physical activity <br />
* Stress<br />
<br />
===Complications===<br />
Uncontrolled Hypertension can cause serious problems, such as:<br />
* Heart attack or stroke<br />
* Aneurysm<br />
* Heart failure <br />
* Kidney damage<br />
* Vision problems<br />
* Peripheral artery disease (PAD) <br />
* Hypertensive crisis<br />
* Sexual dysfunction</div>
Ifeoma odukwe
https://www.wikidoc.org/index.php?title=Sandbox:_zaida&diff=1609564
Sandbox: zaida
2020-05-26T17:31:06Z
<p>Ifeoma odukwe: /* Types */</p>
<hr />
<div>==Hypertension==<br />
===Types===<br />
There are two types of Hypertension:<br />
<br />
'''Primary''': not related to another medical condition<br />
<br />
'''Secodary''': Another medical condition that causes high blood pressure, including:<br />
*[[Kidney]] disease<br />
* Adrenal disease<br />
*[[Hyperparathyroidism]]<br />
*[[Thyroid]] problems<br />
* Coarctation of Aorta<br />
* Obstructive sleep apnea<br />
<br />
===Symptoms===<br />
High blood pressure often has no symptoms, if it's extremely high it might causes symptoms like:<br />
* Sever headache<br />
* Fatigue or confusion<br />
* Blurry vision<br />
* Chest pain<br />
* Dyspnea<br />
* Irregular heartbeat<br />
* Bloody urine<br />
* Pounding sensation in the patient's chest, neck, or ears<br />
<br />
===Risk Factors===<br />
High blood pressure has many risk factors, including:<br />
* Age<br />
* Race<br />
* Family history <br />
* Overweight and obesity <br />
* Tobacco<br />
* High sodium or low potassium diet <br />
* Diabetes <br />
* Lack of physical activity <br />
* Stress<br />
<br />
===Complications===<br />
Uncontrolled Hypertension can cause serious problems, such as:<br />
* Heart attack or stroke<br />
* Aneurysm<br />
* Heart failure <br />
* Kidney damage<br />
* Vision problems<br />
* Peripheral artery disease (PAD) <br />
* Hypertensive crisis<br />
* Sexual dysfunction</div>
Ifeoma odukwe
https://www.wikidoc.org/index.php?title=Dextrocardia_interventions&diff=1609175
Dextrocardia interventions
2020-05-22T14:33:38Z
<p>Ifeoma odukwe: Created page with "__NOTOC__ {{Dextrocardia}} {{CMG}}; {{AE}} ==Overview== There are no recommended therapeutic interventions for the management of [disease name]. OR [name of intervention]..."</p>
<hr />
<div>__NOTOC__<br />
{{Dextrocardia}}<br />
{{CMG}}; {{AE}} <br />
<br />
==Overview==<br />
There are no recommended therapeutic interventions for the management of [disease name].<br />
<br />
OR<br />
<br />
[name of intervention] is not the first-line treatment option for patients with [disease name]. [name of intervention] is usually reserved for patients with either [indication 1], [indication 2], and/or [indication 3].<br />
<br />
OR<br />
<br />
The mainstay of treatment for [disease name] is medical therapy/surgery. [Name of intervention] is usually reserved for patients with either [indication 1], [indication 2], and/or [indication 3].<br />
<br />
OR<br />
<br />
The feasibility of [name of intervention] depends on the stage of [disease or malignancy] at the time of diagnosis.<br />
<br />
OR<br />
<br />
[Name of intervention] is the mainstay of treatment for [disease or malignancy].<br />
<br />
==Indications==<br />
<br />
The mainstay of treatment for TT is medical therapy.<br />
<br />
==References==<br />
{{Reflist|2}}<br />
<br />
{{WH}}<br />
{{WS}}<br />
[[Category: (name of the system)]]</div>
Ifeoma odukwe
https://www.wikidoc.org/index.php?title=Dextrocardia_pathophysiology&diff=1609174
Dextrocardia pathophysiology
2020-05-22T14:31:19Z
<p>Ifeoma odukwe: /* Embryology */</p>
<hr />
<div>__NOTOC__<br />
{{Dextrocardia}}<br />
<br />
{{CMG}}; {{AE}} <br />
==Overview==<br />
The exact pathogenesis of [disease name] is not fully understood.<br />
<br />
OR<br />
<br />
It is thought that [disease name] is the result of / is mediated by / is produced by / is caused by either [hypothesis 1], [hypothesis 2], or [hypothesis 3].<br />
<br />
OR<br />
<br />
[Pathogen name] is usually transmitted via the [transmission route] route to the human host.<br />
<br />
OR<br />
<br />
Following transmission/ingestion, the [pathogen] uses the [entry site] to invade the [cell name] cell.<br />
<br />
OR<br />
<br />
<br />
[Disease or malignancy name] arises from [cell name]s, which are [cell type] cells that are normally involved in [function of cells].<br />
<br />
OR<br />
<br />
The progression to [disease name] usually involves the [molecular pathway].<br />
<br />
OR<br />
<br />
The pathophysiology of [disease/malignancy] depends on the histological subtype.<br />
<br />
==Pathophysiology==<br />
===Embryology===<br />
*The fetal heart forms from an embryonic heart tube. The heart tube is formed by fusion of the endocardial tubes.<ref name="pmid21861958">{{cite journal| author=Perloff JK| title=The cardiac malpositions. | journal=Am J Cardiol | year= 2011 | volume= 108 | issue= 9 | pages= 1352-61 | pmid=21861958 | doi=10.1016/j.amjcard.2011.06.055 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21861958 }} </ref><ref name="pmid5120229">{{cite journal| author=De la Cruz MV, Anselmi G, Munos-Castellanos L, Nadal-Ginard B, Munoz-Armas S| title=Systematization and embryological and anatomical study of mirror-image dextrocardias, dextroversions, and laevoversions. | journal=Br Heart J | year= 1971 | volume= 33 | issue= 6 | pages= 841-53 | pmid=5120229 | doi=10.1136/hrt.33.6.841 | pmc=458437 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=5120229 }} </ref><ref name="pmid7787459">{{cite journal| author=Angelini P| title=Embryology and congenital heart disease. | journal=Tex Heart Inst J | year= 1995 | volume= 22 | issue= 1 | pages= 1-12 | pmid=7787459 | doi= | pmc=325204 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7787459 }} </ref><br />
*The cranial portion of the heart tube attaches to the arterial trunk and the caudal connects to the venous channels.<br />
*The next step after the formation of the heart tube is looping which dictates the position of the ventricle in relationship to the atria. If the heart tube loops to the right (D-loop), the morphologic right ventricle is positioned to the right of the left ventricle. If it loops to the left (L-loop), the morphologic right ventricle is positioned to the left of the left ventricle.<br />
<br />
===Pathogenesis===<br />
*Dextrocardia is a cardiac anomaly in which the major axis of the heart from base to apex points to the right side, in contrast to the normal orientation of the heart where the apex points to the left side. The term dextrocardia outlines the position of the cardiac axis only and not the chamber organisation and structural anatomy of the heart.<ref name="pmid26411880">{{cite journal| author=Ogunlade O, Ayoka AO, Akomolafe RO, Akinsomisoye OS, Irinoye AI, Ajao A | display-authors=etal| title=The role of electrocardiogram in the diagnosis of dextrocardia with mirror image atrial arrangement and ventricular position in a young adult Nigerian in Ile-Ife: a case report. | journal=J Med Case Rep | year= 2015 | volume= 9 | issue= | pages= 222 | pmid=26411880 | doi=10.1186/s13256-015-0695-4 | pmc=4584464 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26411880 }} </ref><ref name="pmid16287744">{{cite journal| author=Bernasconi A, Azancot A, Simpson JM, Jones A, Sharland GK| title=Fetal dextrocardia: diagnosis and outcome in two tertiary centres. | journal=Heart | year= 2005 | volume= 91 | issue= 12 | pages= 1590-4 | pmid=16287744 | doi=10.1136/hrt.2004.048330 | pmc=1769217 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16287744 }} </ref><br />
*The malposition is not as a result of any extracardiac abnormalities but intrinsic to the heart. It is as a result of embryological abnormalities that occur during the development of the heart.<ref name="MaldjianSaric2007">{{cite journal|last1=Maldjian|first1=Pierre D.|last2=Saric|first2=Muhamed|title=Approach to Dextrocardia in Adults:Review|journal=American Journal of Roentgenology|volume=188|issue=6_supplement|year=2007|pages=S39–S49|issn=0361-803X|doi=10.2214/AJR.06.1179}}</ref><br />
*Failure of migration of the D-bulboventricular loop into the left hemithorax can result in dextrocardia with the heart in the right hemithorax. Also, the complete rotation of the L-bulboventricular loop in the right hemithorax can result in the heart situated in the right hemithorax.<br />
*Dextrocardia with a normal abdominal situs has a 90 to 95% chance of associated congenital cardiac anomalies including atrial septal defect, transposition of the great vessels, and ventricular septal defect. It has a lower incidence (0 to 10%) in the presence of situs inversus.<ref name="KumarSingh2014">{{cite journal|last1=Kumar|first1=Abnish|last2=Singh|first2=Manoj Kumar|last3=Yadav|first3=Neeraj|title=Dextrocardia and asplenia in situs inversus totalis in a baby: a case report|journal=Journal of Medical Case Reports|volume=8|issue=1|year=2014|issn=1752-1947|doi=10.1186/1752-1947-8-408}}</ref><br />
<br />
==Genetics==<br />
Genes involved in the pathogenesis of dextrocrdia include:<ref name="FahedGelb2013">{{cite journal|last1=Fahed|first1=Akl C.|last2=Gelb|first2=Bruce D.|last3=Seidman|first3=J. G.|last4=Seidman|first4=Christine E.|title=Genetics of Congenital Heart Disease|journal=Circulation Research|volume=112|issue=4|year=2013|pages=707–720|issn=0009-7330|doi=10.1161/CIRCRESAHA.112.300853}}</ref><br />
*ZIC3<br />
*ACVR2B<br />
*NODAL<br />
<br />
==Associated Conditions==<br />
Conditions associated with [disease name] include:<ref name="pmid27330607">{{cite journal| author=Khoury M, Harbieh B, Heriopian A| title=Isolated dextrocardia and congenital heart blocking. | journal=Radiol Case Rep | year= 2013 | volume= 8 | issue= 1 | pages= 521 | pmid=27330607 | doi=10.2484/rcr.v8i1.521 | pmc=4900208 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27330607 }} </ref><ref name="pmid22605582">{{cite journal| author=Panneerselvam A, Subbiahnadar P| title=Is it dextrocardia or dextroversion? | journal=BMJ Case Rep | year= 2012 | volume= 2012 | issue= | pages= | pmid=22605582 | doi=10.1136/bcr.01.2012.5493 | pmc=3316784 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22605582 }} </ref><ref name="pmid26411880">{{cite journal| author=Ogunlade O, Ayoka AO, Akomolafe RO, Akinsomisoye OS, Irinoye AI, Ajao A | display-authors=etal| title=The role of electrocardiogram in the diagnosis of dextrocardia with mirror image atrial arrangement and ventricular position in a young adult Nigerian in Ile-Ife: a case report. | journal=J Med Case Rep | year= 2015 | volume= 9 | issue= | pages= 222 | pmid=26411880 | doi=10.1186/s13256-015-0695-4 | pmc=4584464 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26411880 }} </ref><ref name="MaldjianSaric2007">{{cite journal|last1=Maldjian|first1=Pierre D.|last2=Saric|first2=Muhamed|title=Approach to Dextrocardia in Adults:Review|journal=American Journal of Roentgenology|volume=188|issue=6_supplement|year=2007|pages=S39–S49|issn=0361-803X|doi=10.2214/AJR.06.1179}}</ref><br />
*Tricuspid atresia<br />
*Transposition of the great vessels<br />
*Pulmonary stenosis<br />
*Double-outlet double-inlet ventricle<br />
*Single ventricle<br />
*Sick sinus syndrome<br />
*Situs inversus<br />
*Situs solitus<br />
*Situs ambiguous<br />
*Kartagener syndrome<br />
*Double-outlet or double-inlet ventricles<br />
<br />
==References==<br />
{{Reflist|2}}<br />
<br />
{{WH}}<br />
{{WS}}<br />
[[Category: (name of the system)]]</div>
Ifeoma odukwe
https://www.wikidoc.org/index.php?title=Dextrocardia_pathophysiology&diff=1609173
Dextrocardia pathophysiology
2020-05-22T14:30:16Z
<p>Ifeoma odukwe: /* Embryology */</p>
<hr />
<div>__NOTOC__<br />
{{Dextrocardia}}<br />
<br />
{{CMG}}; {{AE}} <br />
==Overview==<br />
The exact pathogenesis of [disease name] is not fully understood.<br />
<br />
OR<br />
<br />
It is thought that [disease name] is the result of / is mediated by / is produced by / is caused by either [hypothesis 1], [hypothesis 2], or [hypothesis 3].<br />
<br />
OR<br />
<br />
[Pathogen name] is usually transmitted via the [transmission route] route to the human host.<br />
<br />
OR<br />
<br />
Following transmission/ingestion, the [pathogen] uses the [entry site] to invade the [cell name] cell.<br />
<br />
OR<br />
<br />
<br />
[Disease or malignancy name] arises from [cell name]s, which are [cell type] cells that are normally involved in [function of cells].<br />
<br />
OR<br />
<br />
The progression to [disease name] usually involves the [molecular pathway].<br />
<br />
OR<br />
<br />
The pathophysiology of [disease/malignancy] depends on the histological subtype.<br />
<br />
==Pathophysiology==<br />
===Embryology===<br />
*The fetal heart forms from an embryonic heart tube. The heart tube is formed by fusion of the endocardial tubes.<ref name="pmid21861958">{{cite journal| author=Perloff JK| title=The cardiac malpositions. | journal=Am J Cardiol | year= 2011 | volume= 108 | issue= 9 | pages= 1352-61 | pmid=21861958 | doi=10.1016/j.amjcard.2011.06.055 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21861958 }} </ref><ref name="pmid5120229">{{cite journal| author=De la Cruz MV, Anselmi G, Munos-Castellanos L, Nadal-Ginard B, Munoz-Armas S| title=Systematization and embryological and anatomical study of mirror-image dextrocardias, dextroversions, and laevoversions. | journal=Br Heart J | year= 1971 | volume= 33 | issue= 6 | pages= 841-53 | pmid=5120229 | doi=10.1136/hrt.33.6.841 | pmc=458437 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=5120229 }} </ref><ref name="pmid7787459">{{cite journal| author=Angelini P| title=Embryology and congenital heart disease. | journal=Tex Heart Inst J | year= 1995 | volume= 22 | issue= 1 | pages= 1-12 | pmid=7787459 | doi= | pmc=325204 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7787459 }} </ref><br />
*The cranial portion of the heart tube attaches to the arterial trunk and the caudal connects to the venous channels.<ref name="pmid21224930">{{cite journal| author=Murtuza B, Gupta P, Goli G, Lall KS| title=Coronary revascularization in adults with dextrocardia: surgical implications of the anatomic variants. | journal=Tex Heart Inst J | year= 2010 | volume= 37 | issue= 6 | pages= 633-40 | pmid=21224930 | doi= | pmc=3014129 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21224930 }} </ref><br />
*The next step after the formation of the heart tube is looping which dictates the position of the ventricle in relationship to the atria. If the heart tube loops to the right (D-loop), the morphologic right ventricle is positioned to the right of the left ventricle. If it loops to the left (L-loop), the morphologic right ventricle is positioned to the left of the left ventricle.<br />
<br />
===Pathogenesis===<br />
*Dextrocardia is a cardiac anomaly in which the major axis of the heart from base to apex points to the right side, in contrast to the normal orientation of the heart where the apex points to the left side. The term dextrocardia outlines the position of the cardiac axis only and not the chamber organisation and structural anatomy of the heart.<ref name="pmid26411880">{{cite journal| author=Ogunlade O, Ayoka AO, Akomolafe RO, Akinsomisoye OS, Irinoye AI, Ajao A | display-authors=etal| title=The role of electrocardiogram in the diagnosis of dextrocardia with mirror image atrial arrangement and ventricular position in a young adult Nigerian in Ile-Ife: a case report. | journal=J Med Case Rep | year= 2015 | volume= 9 | issue= | pages= 222 | pmid=26411880 | doi=10.1186/s13256-015-0695-4 | pmc=4584464 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26411880 }} </ref><ref name="pmid16287744">{{cite journal| author=Bernasconi A, Azancot A, Simpson JM, Jones A, Sharland GK| title=Fetal dextrocardia: diagnosis and outcome in two tertiary centres. | journal=Heart | year= 2005 | volume= 91 | issue= 12 | pages= 1590-4 | pmid=16287744 | doi=10.1136/hrt.2004.048330 | pmc=1769217 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16287744 }} </ref><br />
*The malposition is not as a result of any extracardiac abnormalities but intrinsic to the heart. It is as a result of embryological abnormalities that occur during the development of the heart.<ref name="MaldjianSaric2007">{{cite journal|last1=Maldjian|first1=Pierre D.|last2=Saric|first2=Muhamed|title=Approach to Dextrocardia in Adults:Review|journal=American Journal of Roentgenology|volume=188|issue=6_supplement|year=2007|pages=S39–S49|issn=0361-803X|doi=10.2214/AJR.06.1179}}</ref><br />
*Failure of migration of the D-bulboventricular loop into the left hemithorax can result in dextrocardia with the heart in the right hemithorax. Also, the complete rotation of the L-bulboventricular loop in the right hemithorax can result in the heart situated in the right hemithorax.<br />
*Dextrocardia with a normal abdominal situs has a 90 to 95% chance of associated congenital cardiac anomalies including atrial septal defect, transposition of the great vessels, and ventricular septal defect. It has a lower incidence (0 to 10%) in the presence of situs inversus.<ref name="KumarSingh2014">{{cite journal|last1=Kumar|first1=Abnish|last2=Singh|first2=Manoj Kumar|last3=Yadav|first3=Neeraj|title=Dextrocardia and asplenia in situs inversus totalis in a baby: a case report|journal=Journal of Medical Case Reports|volume=8|issue=1|year=2014|issn=1752-1947|doi=10.1186/1752-1947-8-408}}</ref><br />
<br />
==Genetics==<br />
Genes involved in the pathogenesis of dextrocrdia include:<ref name="FahedGelb2013">{{cite journal|last1=Fahed|first1=Akl C.|last2=Gelb|first2=Bruce D.|last3=Seidman|first3=J. G.|last4=Seidman|first4=Christine E.|title=Genetics of Congenital Heart Disease|journal=Circulation Research|volume=112|issue=4|year=2013|pages=707–720|issn=0009-7330|doi=10.1161/CIRCRESAHA.112.300853}}</ref><br />
*ZIC3<br />
*ACVR2B<br />
*NODAL<br />
<br />
==Associated Conditions==<br />
Conditions associated with [disease name] include:<ref name="pmid27330607">{{cite journal| author=Khoury M, Harbieh B, Heriopian A| title=Isolated dextrocardia and congenital heart blocking. | journal=Radiol Case Rep | year= 2013 | volume= 8 | issue= 1 | pages= 521 | pmid=27330607 | doi=10.2484/rcr.v8i1.521 | pmc=4900208 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27330607 }} </ref><ref name="pmid22605582">{{cite journal| author=Panneerselvam A, Subbiahnadar P| title=Is it dextrocardia or dextroversion? | journal=BMJ Case Rep | year= 2012 | volume= 2012 | issue= | pages= | pmid=22605582 | doi=10.1136/bcr.01.2012.5493 | pmc=3316784 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22605582 }} </ref><ref name="pmid26411880">{{cite journal| author=Ogunlade O, Ayoka AO, Akomolafe RO, Akinsomisoye OS, Irinoye AI, Ajao A | display-authors=etal| title=The role of electrocardiogram in the diagnosis of dextrocardia with mirror image atrial arrangement and ventricular position in a young adult Nigerian in Ile-Ife: a case report. | journal=J Med Case Rep | year= 2015 | volume= 9 | issue= | pages= 222 | pmid=26411880 | doi=10.1186/s13256-015-0695-4 | pmc=4584464 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26411880 }} </ref><ref name="MaldjianSaric2007">{{cite journal|last1=Maldjian|first1=Pierre D.|last2=Saric|first2=Muhamed|title=Approach to Dextrocardia in Adults:Review|journal=American Journal of Roentgenology|volume=188|issue=6_supplement|year=2007|pages=S39–S49|issn=0361-803X|doi=10.2214/AJR.06.1179}}</ref><br />
*Tricuspid atresia<br />
*Transposition of the great vessels<br />
*Pulmonary stenosis<br />
*Double-outlet double-inlet ventricle<br />
*Single ventricle<br />
*Sick sinus syndrome<br />
*Situs inversus<br />
*Situs solitus<br />
*Situs ambiguous<br />
*Kartagener syndrome<br />
*Double-outlet or double-inlet ventricles<br />
<br />
==References==<br />
{{Reflist|2}}<br />
<br />
{{WH}}<br />
{{WS}}<br />
[[Category: (name of the system)]]</div>
Ifeoma odukwe
https://www.wikidoc.org/index.php?title=Fibroadenoma_pathophysiology&diff=1609169
Fibroadenoma pathophysiology
2020-05-22T14:20:37Z
<p>Ifeoma odukwe: /* Overview */</p>
<hr />
<div>__NOTOC__<br />
{{Fibroadenoma}}<br />
{{CMG}} {{AE}} {{IO}} {{HL}} <br />
==Overview==<br />
Fibroadenoma is a common [[benign]] [[tumor]] of the [[breast]]. Fibroadenoma arises from [[connective tissue]] [[cell]]s, which are cells that are normally involved in the functional and mechanical support of the surrounding [[Tissue (biology)|tissues]]. Fibroadenomas may demonstrate [[estrogen]] and [[progesterone]] sensitivity and may grow during [[pregnancy]]. The mediator complex subunit 12 (MED12) [[gene]] is the most common [[gene]] involved in the pathogenesis of fibroadenoma. On [[gross pathology]], a rubbery, tan colored, and lobulated mass is a characteristic finding of fibroadenoma. On [[microscopic]] pathology, charectersitic findings of fibroadenoma include a biphasic proliferation of both [[stromal]] and [[epithelial]] components that can be arranged in two growth patterns; a pericanalicular growth pattern and an intracanalicular growth pattern.<br />
<br />
==Pathophysiology==<br />
===Breast physiology===<br />
* Hormones and growth factors act on connective tissue cells in the [[breast]] to regulate the development, maturation, and differentiation of [[Mammary gland|mammary glands]].<ref name="pmid25905225">{{cite journal |vauthors=Feingold KR, Anawalt B, Boyce A, Chrousos G, Dungan K, Grossman A, Hershman JM, Kaltsas G, Koch C, Kopp P, Korbonits M, McLachlan R, Morley JE, New M, Perreault L, Purnell J, Rebar R, Singer F, Trence DL, Vinik A, Wilson DP, Santen RJ |title= |journal= |volume= |issue= |pages= |date= |pmid=25905225 |doi= |url=}}</ref><br />
* [[Estrogen]] is responsible for mediation of the development of ductal tisuue. [[Progesterone]] promotes ductal branching and lobulo-alveolar development. While [[prolactin]] regulates the production of milk protein.<br />
* [[Estrogen]] and [[progesterone]] levels increase at [[puberty]] and initiates [[breast]] development. This development results in the formation of a complex tree-like structure which comprises of primary milk ducts (about 5 to 10) that originate from the nipple, segmental ducts (about 20 to 40), and sub-segmental ducts (about 10 to 100) that end in terminal duct lobular units. The increase in these hormones during the [[menstrual cycle]] stimulates cell proliferation in the luteal phase.<br />
<br />
===Pathogenesis===<br />
* Fibroadenoma is a common [[benign]] [[tumor]] of the [[breast]]. The pathogenesis is not completely understood.<br />
* Fibroadenoma is a proliferation of stromal and epithelial connective tissue cells (biphasic) originating from the terminal duct-lobular unit. Analysis of the stromal and epithelial cells showed that both are polyclonal, which supports the theory that fibroadenomas are hyperplastic lesions associated with a deviation from the normal maturation of the breast, rather than a true neoplasm.<ref name="pmid24872735">{{cite journal |vauthors=Cerrato F, Labow BI |title=Diagnosis and management of fibroadenomas in the adolescent breast |journal=Semin Plast Surg |volume=27 |issue=1 |pages=23–5 |date=February 2013 |pmid=24872735 |pmc=3706050 |doi=10.1055/s-0033-1343992 |url=}}</ref><ref name="pmid8395336">{{cite journal |vauthors=Noguchi S, Motomura K, Inaji H, Imaoka S, Koyama H |title=Clonal analysis of fibroadenoma and phyllodes tumor of the breast |journal=Cancer Res. |volume=53 |issue=17 |pages=4071–4 |date=September 1993 |pmid=8395336 |doi= |url=}}</ref><br />
* In some patients, fibroadenomas may express [[estrogen]] and [[progesterone]] receptors. These hormones stimulate the fibroadenomas via hormone-receptor mechanism leading to excessive proliferation of epithelial and stromal cells. They undergo atrophy during menopause.<ref name="pmid9754521">{{cite journal |vauthors=Greenberg R, Skornick Y, Kaplan O |title=Management of breast fibroadenomas |journal=J Gen Intern Med |volume=13 |issue=9 |pages=640–5 |date=September 1998 |pmid=9754521 |pmc=1497021 |doi= |url=}}</ref><br />
* Some fibroadenomas may express epidermal growth factor (EGF) receptors.<ref name="pmid9754521">{{cite journal |vauthors=Greenberg R, Skornick Y, Kaplan O |title=Management of breast fibroadenomas |journal=J Gen Intern Med |volume=13 |issue=9 |pages=640–5 |date=September 1998 |pmid=9754521 |pmc=1497021 |doi= |url=}}</ref><br />
* More than 70% of fibroadenomas present as a single mass, and 10%–25% of fibroadenomas present as multiple masses.<ref name="pmid26366109">{{cite journal |vauthors=Lee M, Soltanian HT |title=Breast fibroadenomas in adolescents: current perspectives |journal=Adolesc Health Med Ther |volume=6 |issue= |pages=159–63 |date=2015 |pmid=26366109 |pmc=4562655 |doi=10.2147/AHMT.S55833 |url=}}</ref><br />
* Although fibroadenomas may be develop in any part of the [[breast]], there is a significant predilection for the upper outer quadrant. The mass may enlarge slowly without associated pain or nipple and skin changes, but fluctuations in size may occur with the menstrual cycle. <ref name="pmid24872735">{{cite journal |vauthors=Cerrato F, Labow BI |title=Diagnosis and management of fibroadenomas in the adolescent breast |journal=Semin Plast Surg |volume=27 |issue=1 |pages=23–5 |date=February 2013 |pmid=24872735 |pmc=3706050 |doi=10.1055/s-0033-1343992 |url=}}</ref><br />
<br />
==Genetics==<br />
* The mediator complex subunit 12 (MED12) [[gene]] is involved in the pathophysiology of fibroadenoma. The MED12 [[gene]] helps in producing the MED12 protein which with other proteins, is essential for eukaryotic transcriptional regulation.<ref name="pmid30570966">{{cite journal |vauthors=Ajmal M, Van Fossen K |title= |journal= |volume= |issue= |pages= |date= |pmid=30570966 |doi= |url=}}</ref><ref name="pmid17716226">{{cite journal| author=Philibert RA, Madan A| title=Role of MED12 in transcription and human behavior. | journal=Pharmacogenomics | year= 2007 | volume= 8 | issue= 8 | pages= 909-16 | pmid=17716226 | doi=10.2217/14622416.8.8.909 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17716226 }} </ref><br />
<br />
==Associated Conditions==<br />
Conditions associated with fibroadenoma include:<ref name="pmid26366109">{{cite journal |vauthors=Lee M, Soltanian HT |title=Breast fibroadenomas in adolescents: current perspectives |journal=Adolesc Health Med Ther |volume=6 |issue= |pages=159–63 |date=2015 |pmid=26366109 |pmc=4562655 |doi=10.2147/AHMT.S55833 |url=}}</ref><br />
<br />
*[[Beckwith-Wiedemann syndrome]]<br />
*[[Maffucci syndrome]]<br />
*[[Cowden syndrome]]<br />
<br />
==Gross Pathology==<br />
* On gross pathology, a painless, firm, solitary, mobile, and slowly growing breast [[lump]] is a characteristic finding of fibroadenoma.<br />
* Other charectersitic findings on gross examination of fibroadenoma include:<ref name="wiki">Fibroadenoma. Wikipedia (2015) https://en.wikipedia.org/wiki/Fibroadenoma Accessed on January, 29 2016</ref><ref name="patho">Fibroadenoma. Libre Pathology (2015) http://librepathology.org/wiki/index.php/Fibroadenoma Accessed on January, 29 2016</ref><ref name="patho2">Breast-nonmalignant-Fibroadenoma. PathologyOutlines (2015) http://www.pathologyoutlines.com/topic/breastfibroadenoma.html Accessed on January, 29 2016</ref><ref name="radio">Fibroadenoma. Radiopaedia (2015) http://radiopaedia.org/articles/fibroadenoma-of-the-breast-1 Accessed on January, 29 2016</ref><br />
:* Rubbery texture<br />
:* Tan/white colored<br />
:* Lobulated appearance<br />
:* Short slit-like spaces present<br />
:* [[Calcification]]s<br />
* Fibroadenomas may sometimes be referred to as a "breast mouse", owing to the high mobility of the tumor through out the breast tissue.<br />
[[File:FibroAdenoma of the breast.JPG|400px|thumb|left|Cut section of the breast showing fibroadenoma [https://commons.wikimedia.org/wiki/File:FibroAdenoma_of_the_breast.JPG source:Netha Hussain ]]]<br />
<br style="clear:left" /><br />
<br />
==Microscopic Pathology==<br />
* On microscopic pathology, charectersitic findings of fibroadenoma include:<ref name="wiki">Fibroadenoma. Wikipedia (2015) https://en.wikipedia.org/wiki/Fibroadenoma Accessed on January, 29 2016</ref><ref name="patho">Fibroadenoma. Libre Pathology (2015) http://librepathology.org/wiki/index.php/Fibroadenoma Accessed on January, 29 2016</ref><ref name="patho2">Breast-nonmalignant-Fibroadenoma. PathologyOutlines (2015) http://www.pathologyoutlines.com/topic/breastfibroadenoma.html Accessed on January, 29 2016</ref><ref name="radio">Fibroadenoma. Radiopaedia (2015) http://radiopaedia.org/articles/fibroadenoma-of-the-breast-1 Accessed on January, 29 2016</ref><br />
:* Uniformly distributed sheets of epithelial cells arranged in a honeycomb pattern<br />
:* Presence of foam and apocrine cells<br />
:* Intact basement membrane<br />
:* A hypovascular stroma <br />
:* [[Calcification]] may be present<br />
:* Absence of excessive [[mitotic]] figures or anaplasia<br />
:* Biphasic proliferation of both stromal and epithelial components that can be arranged in two growth patterns: <br />
::* Pericanalicular growth pattern: stromal proliferation around epithelial structures <br />
::* Intracanalicular growth pattern: stromal proliferation compressing the epithelial structures into clefts<br />
<br />
[[File:Histology fibro 1.jpg|400px|thumb|left|H&E stain showing proliferation of intralobular stroma compressing and distorting the epithelium [https://commons.wikimedia.org/wiki/File:Fibroadenoma_10X.jpg#/media/File:Fibroadenoma_10X.jpg Source:Department of Pathology, Calicut Medical College]]]<br />
<br style="clear:left" /><br />
<br style="clear:left" /><br />
<br />
<br />
==References==<br />
{{reflist|2}}<br />
<br />
{{Soft tissue tumors and sarcomas}}<br />
<br />
[[Category:Breast]]<br />
[[Category:Primary care]]<br />
<br />
{{WH}}<br />
{{WS}}<br />
[[Category:Up-To-Date]]<br />
[[Category:Oncology]]<br />
[[Category:Medicine]]</div>
Ifeoma odukwe
https://www.wikidoc.org/index.php?title=Sandbox:_ifrah&diff=1609162
Sandbox: ifrah
2020-05-22T14:16:35Z
<p>Ifeoma odukwe: /* Definition */</p>
<hr />
<div><br />
{{SK}} [[Diabetes]]; [[Diabetes insipidus]]; Diabetes insipidus; Congenital nephrogenic Diabetes insipidus; Cranial<br />
Diabetes insipidus; nephrogenic<br />
Diabetes insipidus; non-nephrogenic<br />
Diabetes insipidus; renal<br />
Diabetes mellitus type 1<br />
<br />
==Definition==<br />
Diabetes mellitus is a metabolic disease that results in dysregulation of blood sugar in the body.<br />
<br />
== Types ==<br />
<br />
*Type 1 Diabetes Mellitus<br />
*Type 2 Diabetes Mellitus<br />
<br />
===Type 1 Diabetes Mellitus===<br />
<br />
* Sudden onset<br />
* Age: Any age, but mostly young<br />
* '''ketoacidosis''' common<br />
* Endogenous insulin ''low'' or '''''absent'''''<br />
<br />
=== Type 2 Diabetes mellitus===<br />
<br />
* Gradual onset<br />
* Age: Mostly adults<br />
** May occur in younger individuals <br />
* Ketoacidosis ''rare''<br />
* Endogenous insulin may be<br />
*# normal<br />
*# increased or<br />
*# decreased<br />
<br />
== Symptoms ==<br />
* [[Diabetes mellitus]] is usually asymptomatic.<br />
*Symptoms of [[Diabetes]] may include the following:<br />
:*[[Polyuria]]<br />
:*[[Polydipsia]]<br />
:*[[Polyphagia]]<br />
:*[[Fatigue]]</div>
Ifeoma odukwe
https://www.wikidoc.org/index.php?title=Dextrocardia_natural_history,_complications_and_prognosis&diff=1609117
Dextrocardia natural history, complications and prognosis
2020-05-21T18:22:08Z
<p>Ifeoma odukwe: /* Complications */</p>
<hr />
<div>__NOTOC__<br />
{{Dextrocardia}}<br />
<br />
{{CMG}}; {{AE}} <br />
<br />
==Overview==<br />
If left untreated, [#]% of patients with [disease name] may progress to develop [manifestation 1], [manifestation 2], and [manifestation 3].<br />
<br />
OR<br />
<br />
Common complications of [disease name] include [complication 1], [complication 2], and [complication 3].<br />
<br />
OR<br />
<br />
Prognosis is generally excellent/good/poor, and the 1/5/10-year mortality/survival rate of patients with [disease name] is approximately [#]%.<br />
==Natural History, Complications, and Prognosis==<br />
<br />
===Natural History===<br />
*The symptoms of (disease name) usually develop in the first/ second/ third decade of life, and start with symptoms such as ___. <br />
*The symptoms of (disease name) typically develop ___ years after exposure to ___. <br />
*If left untreated, [#]% of patients with [disease name] may progress to develop [manifestation 1], [manifestation 2], and [manifestation 3].<br />
<br />
===Complications===<br />
The complications seen in patients with dextrocardia are predominantly from the complex cardiac and extra-cardiac anomalies associated with dextrocardia.<ref name="pmid26541676">{{cite journal| author=Offen S, Jackson D, Canniffe C, Choudhary P, Celermajer DS| title=Dextrocardia in Adults with Congenital Heart Disease. | journal=Heart Lung Circ | year= 2016 | volume= 25 | issue= 4 | pages= 352-7 | pmid=26541676 | doi=10.1016/j.hlc.2015.09.003 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26541676 }} </ref><br />
<br />
===Prognosis===<br />
*Prognosis is generally excellent/good/poor, and the 1/5/10-year mortality/survival rate of patients with [disease name] is approximately [--]%.<br />
*Depending on the extent of the [tumor/disease progression] at the time of diagnosis, the prognosis may vary. However, the prognosis is generally regarded as poor/good/excellent.<br />
*The presence of [characteristic of disease] is associated with a particularly [good/poor] prognosis among patients with [disease/malignancy].<br />
*[Subtype of disease/malignancy] is associated with the most favorable prognosis.<br />
*The prognosis varies with the [characteristic] of tumor; [subtype of disease/malignancy] have the most favorable prognosis.<br />
<br />
==References==<br />
{{Reflist|2}}<br />
<br />
{{WH}}<br />
{{WS}}<br />
[[Category: (name of the system)]]</div>
Ifeoma odukwe
https://www.wikidoc.org/index.php?title=Dextrocardia_natural_history,_complications_and_prognosis&diff=1609116
Dextrocardia natural history, complications and prognosis
2020-05-21T18:20:56Z
<p>Ifeoma odukwe: /* Complications */</p>
<hr />
<div>__NOTOC__<br />
{{Dextrocardia}}<br />
<br />
{{CMG}}; {{AE}} <br />
<br />
==Overview==<br />
If left untreated, [#]% of patients with [disease name] may progress to develop [manifestation 1], [manifestation 2], and [manifestation 3].<br />
<br />
OR<br />
<br />
Common complications of [disease name] include [complication 1], [complication 2], and [complication 3].<br />
<br />
OR<br />
<br />
Prognosis is generally excellent/good/poor, and the 1/5/10-year mortality/survival rate of patients with [disease name] is approximately [#]%.<br />
==Natural History, Complications, and Prognosis==<br />
<br />
===Natural History===<br />
*The symptoms of (disease name) usually develop in the first/ second/ third decade of life, and start with symptoms such as ___. <br />
*The symptoms of (disease name) typically develop ___ years after exposure to ___. <br />
*If left untreated, [#]% of patients with [disease name] may progress to develop [manifestation 1], [manifestation 2], and [manifestation 3].<br />
<br />
===Complications===<br />
The complications seen in patients with dextrocardia are predominantly from the complex cardiac and extra-cardiac anomalies associated with dextrocardia.<br />
<br />
===Prognosis===<br />
*Prognosis is generally excellent/good/poor, and the 1/5/10-year mortality/survival rate of patients with [disease name] is approximately [--]%.<br />
*Depending on the extent of the [tumor/disease progression] at the time of diagnosis, the prognosis may vary. However, the prognosis is generally regarded as poor/good/excellent.<br />
*The presence of [characteristic of disease] is associated with a particularly [good/poor] prognosis among patients with [disease/malignancy].<br />
*[Subtype of disease/malignancy] is associated with the most favorable prognosis.<br />
*The prognosis varies with the [characteristic] of tumor; [subtype of disease/malignancy] have the most favorable prognosis.<br />
<br />
==References==<br />
{{Reflist|2}}<br />
<br />
{{WH}}<br />
{{WS}}<br />
[[Category: (name of the system)]]</div>
Ifeoma odukwe
https://www.wikidoc.org/index.php?title=Dextrocardia_history_and_symptoms&diff=1608835
Dextrocardia history and symptoms
2020-05-18T20:46:31Z
<p>Ifeoma odukwe: /* History */</p>
<hr />
<div>__NOTOC__<br />
{{Dextrocardia}}<br />
<br />
{{CMG}}; {{AE}} <br />
==Overview==<br />
The majority of patients with [disease name] are asymptomatic.<br />
<br />
==History and Symptoms==<br />
===History===<br />
Patients with dextrocardia may have a positive history of:<ref name="pmid25489202">{{cite journal| author=Arunabha DC, Sumit RT, Sourin B, Sabyasachi C, Subhasis M| title=Kartagener's syndrome: a classical case. | journal=Ethiop J Health Sci | year= 2014 | volume= 24 | issue= 4 | pages= 363-8 | pmid=25489202 | doi=10.4314/ejhs.v24i4.13 | pmc=4248037 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25489202 }} </ref><ref name="pmid17515336">{{cite journal| author=Maldjian PD, Saric M| title=Approach to dextrocardia in adults: review. | journal=AJR Am J Roentgenol | year= 2007 | volume= 188 | issue= 6 Suppl | pages= S39-49; quiz S35-8 | pmid=17515336 | doi=10.2214/AJR.06.1179 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17515336 }} </ref><ref name="pmid24082385">{{cite journal| author=Dilorenzo M, Weinstein S, Shenoy R| title=Tetralogy of fallot with dextrocardia and situs inversus in a 7-year-old boy. | journal=Tex Heart Inst J | year= 2013 | volume= 40 | issue= 4 | pages= 481-3 | pmid=24082385 | doi= | pmc=3783122 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24082385 }} </ref><br />
*Situs inversus<br />
*Kartagener syndrome<br />
*Recurrent respiratory infections<br />
*Reduced exercise tolerance<br />
*Hydrocephalus<br />
<br />
===Symptoms===<br />
Patients with isolated dextrocardia with no associated abnormalities are usually asymptomatic. When dextrocardia occurs with abnormalities such as kartagener syndrome and situs inversus, patients may present with the following symptoms:<ref name="pmid25489202">{{cite journal| author=Arunabha DC, Sumit RT, Sourin B, Sabyasachi C, Subhasis M| title=Kartagener's syndrome: a classical case. | journal=Ethiop J Health Sci | year= 2014 | volume= 24 | issue= 4 | pages= 363-8 | pmid=25489202 | doi=10.4314/ejhs.v24i4.13 | pmc=4248037 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25489202 }} </ref><ref name="pmid17515336">{{cite journal| author=Maldjian PD, Saric M| title=Approach to dextrocardia in adults: review. | journal=AJR Am J Roentgenol | year= 2007 | volume= 188 | issue= 6 Suppl | pages= S39-49; quiz S35-8 | pmid=17515336 | doi=10.2214/AJR.06.1179 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17515336 }} </ref><ref name="pmid24082385">{{cite journal| author=Dilorenzo M, Weinstein S, Shenoy R| title=Tetralogy of fallot with dextrocardia and situs inversus in a 7-year-old boy. | journal=Tex Heart Inst J | year= 2013 | volume= 40 | issue= 4 | pages= 481-3 | pmid=24082385 | doi= | pmc=3783122 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24082385 }} </ref><br />
*[[Cyanosis]]<br />
*[[Dyspnea]]<br />
*Fatigue<br />
*Failure to thrive<br />
*Exercise intolerance<br />
*Recurrent sinus/pulmonary infections<br />
*Arrhythmias<br />
*Abdominal pain due to intestinal obstruction<br />
<br />
==References==<br />
{{Reflist|2}}<br />
<br />
{{WH}}<br />
{{WS}}<br />
[[Category: (name of the system)]]</div>
Ifeoma odukwe
https://www.wikidoc.org/index.php?title=Dextrocardia_history_and_symptoms&diff=1608834
Dextrocardia history and symptoms
2020-05-18T20:39:26Z
<p>Ifeoma odukwe: /* History */</p>
<hr />
<div>__NOTOC__<br />
{{Dextrocardia}}<br />
<br />
{{CMG}}; {{AE}} <br />
==Overview==<br />
The majority of patients with [disease name] are asymptomatic.<br />
<br />
==History and Symptoms==<br />
===History===<br />
Patients with dextrocardia may have a positive history of:<br />
*Situs inversus<br />
*Kartagener syndrome<br />
*Recurrent respiratory infections<br />
*Reduced exercise tolerance<br />
*Hydrocephalus<br />
<br />
===Symptoms===<br />
Patients with isolated dextrocardia with no associated abnormalities are usually asymptomatic. When dextrocardia occurs with abnormalities such as kartagener syndrome and situs inversus, patients may present with the following symptoms:<ref name="pmid25489202">{{cite journal| author=Arunabha DC, Sumit RT, Sourin B, Sabyasachi C, Subhasis M| title=Kartagener's syndrome: a classical case. | journal=Ethiop J Health Sci | year= 2014 | volume= 24 | issue= 4 | pages= 363-8 | pmid=25489202 | doi=10.4314/ejhs.v24i4.13 | pmc=4248037 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25489202 }} </ref><ref name="pmid17515336">{{cite journal| author=Maldjian PD, Saric M| title=Approach to dextrocardia in adults: review. | journal=AJR Am J Roentgenol | year= 2007 | volume= 188 | issue= 6 Suppl | pages= S39-49; quiz S35-8 | pmid=17515336 | doi=10.2214/AJR.06.1179 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17515336 }} </ref><ref name="pmid24082385">{{cite journal| author=Dilorenzo M, Weinstein S, Shenoy R| title=Tetralogy of fallot with dextrocardia and situs inversus in a 7-year-old boy. | journal=Tex Heart Inst J | year= 2013 | volume= 40 | issue= 4 | pages= 481-3 | pmid=24082385 | doi= | pmc=3783122 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24082385 }} </ref><br />
*[[Cyanosis]]<br />
*[[Dyspnea]]<br />
*Fatigue<br />
*Failure to thrive<br />
*Exercise intolerance<br />
*Recurrent sinus/pulmonary infections<br />
*Arrhythmias<br />
*Abdominal pain due to intestinal obstruction<br />
<br />
==References==<br />
{{Reflist|2}}<br />
<br />
{{WH}}<br />
{{WS}}<br />
[[Category: (name of the system)]]</div>
Ifeoma odukwe
https://www.wikidoc.org/index.php?title=Dextrocardia_history_and_symptoms&diff=1608833
Dextrocardia history and symptoms
2020-05-18T20:38:41Z
<p>Ifeoma odukwe: /* History */</p>
<hr />
<div>__NOTOC__<br />
{{Dextrocardia}}<br />
<br />
{{CMG}}; {{AE}} <br />
==Overview==<br />
The majority of patients with [disease name] are asymptomatic.<br />
<br />
==History and Symptoms==<br />
===History===<br />
Patients with dextrocardia may have a positive history of:<br />
*Situs inversus<br />
*Kartagener syndrome<br />
*Recurrent respiratory infections<br />
*Reduced exercise tolerance<br />
<br />
===Symptoms===<br />
Patients with isolated dextrocardia with no associated abnormalities are usually asymptomatic. When dextrocardia occurs with abnormalities such as kartagener syndrome and situs inversus, patients may present with the following symptoms:<ref name="pmid25489202">{{cite journal| author=Arunabha DC, Sumit RT, Sourin B, Sabyasachi C, Subhasis M| title=Kartagener's syndrome: a classical case. | journal=Ethiop J Health Sci | year= 2014 | volume= 24 | issue= 4 | pages= 363-8 | pmid=25489202 | doi=10.4314/ejhs.v24i4.13 | pmc=4248037 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25489202 }} </ref><ref name="pmid17515336">{{cite journal| author=Maldjian PD, Saric M| title=Approach to dextrocardia in adults: review. | journal=AJR Am J Roentgenol | year= 2007 | volume= 188 | issue= 6 Suppl | pages= S39-49; quiz S35-8 | pmid=17515336 | doi=10.2214/AJR.06.1179 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17515336 }} </ref><ref name="pmid24082385">{{cite journal| author=Dilorenzo M, Weinstein S, Shenoy R| title=Tetralogy of fallot with dextrocardia and situs inversus in a 7-year-old boy. | journal=Tex Heart Inst J | year= 2013 | volume= 40 | issue= 4 | pages= 481-3 | pmid=24082385 | doi= | pmc=3783122 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24082385 }} </ref><br />
*[[Cyanosis]]<br />
*[[Dyspnea]]<br />
*Fatigue<br />
*Failure to thrive<br />
*Exercise intolerance<br />
*Recurrent sinus/pulmonary infections<br />
*Arrhythmias<br />
*Abdominal pain due to intestinal obstruction<br />
<br />
==References==<br />
{{Reflist|2}}<br />
<br />
{{WH}}<br />
{{WS}}<br />
[[Category: (name of the system)]]</div>
Ifeoma odukwe
https://www.wikidoc.org/index.php?title=Dextrocardia_history_and_symptoms&diff=1608832
Dextrocardia history and symptoms
2020-05-18T20:31:19Z
<p>Ifeoma odukwe: /* History */</p>
<hr />
<div>__NOTOC__<br />
{{Dextrocardia}}<br />
<br />
{{CMG}}; {{AE}} <br />
==Overview==<br />
The majority of patients with [disease name] are asymptomatic.<br />
<br />
==History and Symptoms==<br />
===History===<br />
Patients with dextrocardia may have a positive history of:<br />
*Situs inversus<br />
*Kartagener syndrome<br />
<br />
===Symptoms===<br />
Patients with isolated dextrocardia with no associated abnormalities are usually asymptomatic. When dextrocardia occurs with abnormalities such as kartagener syndrome and situs inversus, patients may present with the following symptoms:<ref name="pmid25489202">{{cite journal| author=Arunabha DC, Sumit RT, Sourin B, Sabyasachi C, Subhasis M| title=Kartagener's syndrome: a classical case. | journal=Ethiop J Health Sci | year= 2014 | volume= 24 | issue= 4 | pages= 363-8 | pmid=25489202 | doi=10.4314/ejhs.v24i4.13 | pmc=4248037 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25489202 }} </ref><ref name="pmid17515336">{{cite journal| author=Maldjian PD, Saric M| title=Approach to dextrocardia in adults: review. | journal=AJR Am J Roentgenol | year= 2007 | volume= 188 | issue= 6 Suppl | pages= S39-49; quiz S35-8 | pmid=17515336 | doi=10.2214/AJR.06.1179 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17515336 }} </ref><ref name="pmid24082385">{{cite journal| author=Dilorenzo M, Weinstein S, Shenoy R| title=Tetralogy of fallot with dextrocardia and situs inversus in a 7-year-old boy. | journal=Tex Heart Inst J | year= 2013 | volume= 40 | issue= 4 | pages= 481-3 | pmid=24082385 | doi= | pmc=3783122 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24082385 }} </ref><br />
*[[Cyanosis]]<br />
*[[Dyspnea]]<br />
*Fatigue<br />
*Failure to thrive<br />
*Exercise intolerance<br />
*Recurrent sinus/pulmonary infections<br />
*Arrhythmias<br />
*Abdominal pain due to intestinal obstruction<br />
<br />
==References==<br />
{{Reflist|2}}<br />
<br />
{{WH}}<br />
{{WS}}<br />
[[Category: (name of the system)]]</div>
Ifeoma odukwe
https://www.wikidoc.org/index.php?title=Dextrocardia_pathophysiology&diff=1608829
Dextrocardia pathophysiology
2020-05-18T19:37:06Z
<p>Ifeoma odukwe: /* Embryology */</p>
<hr />
<div>__NOTOC__<br />
{{Dextrocardia}}<br />
<br />
{{CMG}}; {{AE}} <br />
==Overview==<br />
The exact pathogenesis of [disease name] is not fully understood.<br />
<br />
OR<br />
<br />
It is thought that [disease name] is the result of / is mediated by / is produced by / is caused by either [hypothesis 1], [hypothesis 2], or [hypothesis 3].<br />
<br />
OR<br />
<br />
[Pathogen name] is usually transmitted via the [transmission route] route to the human host.<br />
<br />
OR<br />
<br />
Following transmission/ingestion, the [pathogen] uses the [entry site] to invade the [cell name] cell.<br />
<br />
OR<br />
<br />
<br />
[Disease or malignancy name] arises from [cell name]s, which are [cell type] cells that are normally involved in [function of cells].<br />
<br />
OR<br />
<br />
The progression to [disease name] usually involves the [molecular pathway].<br />
<br />
OR<br />
<br />
The pathophysiology of [disease/malignancy] depends on the histological subtype.<br />
<br />
==Pathophysiology==<br />
===Embryology===<br />
*The fetal heart forms from an embryonic heart tube. The heart tube is formed by fusion of the endocardial tubes.<ref name="pmid21861958">{{cite journal| author=Perloff JK| title=The cardiac malpositions. | journal=Am J Cardiol | year= 2011 | volume= 108 | issue= 9 | pages= 1352-61 | pmid=21861958 | doi=10.1016/j.amjcard.2011.06.055 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21861958 }} </ref><ref name="pmid5120229">{{cite journal| author=De la Cruz MV, Anselmi G, Munos-Castellanos L, Nadal-Ginard B, Munoz-Armas S| title=Systematization and embryological and anatomical study of mirror-image dextrocardias, dextroversions, and laevoversions. | journal=Br Heart J | year= 1971 | volume= 33 | issue= 6 | pages= 841-53 | pmid=5120229 | doi=10.1136/hrt.33.6.841 | pmc=458437 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=5120229 }} </ref><ref name="pmid7787459">{{cite journal| author=Angelini P| title=Embryology and congenital heart disease. | journal=Tex Heart Inst J | year= 1995 | volume= 22 | issue= 1 | pages= 1-12 | pmid=7787459 | doi= | pmc=325204 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7787459 }} </ref><br />
*The cranial portion of the heart tube attaches to the arterial trunk and the caudal connects to the venous channels.<br />
*The next step after the formation of the heart tube is looping which dictates the position of the ventricle in relationship to the atria. If the heart tube loops to the right (D-loop), the morphologic right ventricle is positioned to the right of the left ventricle. If it loops to the left (L-loop), the morphologic right ventricle is positioned to the left of the left ventricle.<br />
<br />
===Pathogenesis===<br />
*Dextrocardia is a cardiac anomaly in which the major axis of the heart from base to apex points to the right side, in contrast to the normal orientation of the heart where the apex points to the left side. The term dextrocardia outlines the position of the cardiac axis only and not the chamber organisation and structural anatomy of the heart.<ref name="pmid26411880">{{cite journal| author=Ogunlade O, Ayoka AO, Akomolafe RO, Akinsomisoye OS, Irinoye AI, Ajao A | display-authors=etal| title=The role of electrocardiogram in the diagnosis of dextrocardia with mirror image atrial arrangement and ventricular position in a young adult Nigerian in Ile-Ife: a case report. | journal=J Med Case Rep | year= 2015 | volume= 9 | issue= | pages= 222 | pmid=26411880 | doi=10.1186/s13256-015-0695-4 | pmc=4584464 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26411880 }} </ref><ref name="pmid16287744">{{cite journal| author=Bernasconi A, Azancot A, Simpson JM, Jones A, Sharland GK| title=Fetal dextrocardia: diagnosis and outcome in two tertiary centres. | journal=Heart | year= 2005 | volume= 91 | issue= 12 | pages= 1590-4 | pmid=16287744 | doi=10.1136/hrt.2004.048330 | pmc=1769217 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16287744 }} </ref><br />
*The malposition is not as a result of any extracardiac abnormalities but intrinsic to the heart. It is as a result of embryological abnormalities that occur during the development of the heart.<ref name="MaldjianSaric2007">{{cite journal|last1=Maldjian|first1=Pierre D.|last2=Saric|first2=Muhamed|title=Approach to Dextrocardia in Adults:Review|journal=American Journal of Roentgenology|volume=188|issue=6_supplement|year=2007|pages=S39–S49|issn=0361-803X|doi=10.2214/AJR.06.1179}}</ref><br />
*Failure of migration of the D-bulboventricular loop into the left hemithorax can result in dextrocardia with the heart in the right hemithorax. Also, the complete rotation of the L-bulboventricular loop in the right hemithorax can result in the heart situated in the right hemithorax.<br />
*Dextrocardia with a normal abdominal situs has a 90 to 95% chance of associated congenital cardiac anomalies including atrial septal defect, transposition of the great vessels, and ventricular septal defect. It has a lower incidence (0 to 10%) in the presence of situs inversus.<ref name="KumarSingh2014">{{cite journal|last1=Kumar|first1=Abnish|last2=Singh|first2=Manoj Kumar|last3=Yadav|first3=Neeraj|title=Dextrocardia and asplenia in situs inversus totalis in a baby: a case report|journal=Journal of Medical Case Reports|volume=8|issue=1|year=2014|issn=1752-1947|doi=10.1186/1752-1947-8-408}}</ref><br />
<br />
==Genetics==<br />
Genes involved in the pathogenesis of dextrocrdia include:<ref name="FahedGelb2013">{{cite journal|last1=Fahed|first1=Akl C.|last2=Gelb|first2=Bruce D.|last3=Seidman|first3=J. G.|last4=Seidman|first4=Christine E.|title=Genetics of Congenital Heart Disease|journal=Circulation Research|volume=112|issue=4|year=2013|pages=707–720|issn=0009-7330|doi=10.1161/CIRCRESAHA.112.300853}}</ref><br />
*ZIC3<br />
*ACVR2B<br />
*NODAL<br />
<br />
==Associated Conditions==<br />
Conditions associated with [disease name] include:<ref name="pmid27330607">{{cite journal| author=Khoury M, Harbieh B, Heriopian A| title=Isolated dextrocardia and congenital heart blocking. | journal=Radiol Case Rep | year= 2013 | volume= 8 | issue= 1 | pages= 521 | pmid=27330607 | doi=10.2484/rcr.v8i1.521 | pmc=4900208 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27330607 }} </ref><ref name="pmid22605582">{{cite journal| author=Panneerselvam A, Subbiahnadar P| title=Is it dextrocardia or dextroversion? | journal=BMJ Case Rep | year= 2012 | volume= 2012 | issue= | pages= | pmid=22605582 | doi=10.1136/bcr.01.2012.5493 | pmc=3316784 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22605582 }} </ref><ref name="pmid26411880">{{cite journal| author=Ogunlade O, Ayoka AO, Akomolafe RO, Akinsomisoye OS, Irinoye AI, Ajao A | display-authors=etal| title=The role of electrocardiogram in the diagnosis of dextrocardia with mirror image atrial arrangement and ventricular position in a young adult Nigerian in Ile-Ife: a case report. | journal=J Med Case Rep | year= 2015 | volume= 9 | issue= | pages= 222 | pmid=26411880 | doi=10.1186/s13256-015-0695-4 | pmc=4584464 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26411880 }} </ref><ref name="MaldjianSaric2007">{{cite journal|last1=Maldjian|first1=Pierre D.|last2=Saric|first2=Muhamed|title=Approach to Dextrocardia in Adults:Review|journal=American Journal of Roentgenology|volume=188|issue=6_supplement|year=2007|pages=S39–S49|issn=0361-803X|doi=10.2214/AJR.06.1179}}</ref><br />
*Tricuspid atresia<br />
*Transposition of the great vessels<br />
*Pulmonary stenosis<br />
*Double-outlet double-inlet ventricle<br />
*Single ventricle<br />
*Sick sinus syndrome<br />
*Situs inversus<br />
*Situs solitus<br />
*Situs ambiguous<br />
*Kartagener syndrome<br />
*Double-outlet or double-inlet ventricles<br />
<br />
==References==<br />
{{Reflist|2}}<br />
<br />
{{WH}}<br />
{{WS}}<br />
[[Category: (name of the system)]]</div>
Ifeoma odukwe
https://www.wikidoc.org/index.php?title=Dextrocardia_pathophysiology&diff=1608828
Dextrocardia pathophysiology
2020-05-18T19:34:28Z
<p>Ifeoma odukwe: /* Embryology */</p>
<hr />
<div>__NOTOC__<br />
{{Dextrocardia}}<br />
<br />
{{CMG}}; {{AE}} <br />
==Overview==<br />
The exact pathogenesis of [disease name] is not fully understood.<br />
<br />
OR<br />
<br />
It is thought that [disease name] is the result of / is mediated by / is produced by / is caused by either [hypothesis 1], [hypothesis 2], or [hypothesis 3].<br />
<br />
OR<br />
<br />
[Pathogen name] is usually transmitted via the [transmission route] route to the human host.<br />
<br />
OR<br />
<br />
Following transmission/ingestion, the [pathogen] uses the [entry site] to invade the [cell name] cell.<br />
<br />
OR<br />
<br />
<br />
[Disease or malignancy name] arises from [cell name]s, which are [cell type] cells that are normally involved in [function of cells].<br />
<br />
OR<br />
<br />
The progression to [disease name] usually involves the [molecular pathway].<br />
<br />
OR<br />
<br />
The pathophysiology of [disease/malignancy] depends on the histological subtype.<br />
<br />
==Pathophysiology==<br />
===Embryology===<br />
*The fetal heart forms from an embryonic heart tube. The heart tube is formed by fusion of the endocardial tubes.<ref name="pmid21861958">{{cite journal| author=Perloff JK| title=The cardiac malpositions. | journal=Am J Cardiol | year= 2011 | volume= 108 | issue= 9 | pages= 1352-61 | pmid=21861958 | doi=10.1016/j.amjcard.2011.06.055 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21861958 }} </ref><br />
*The cranial portion of the heart tube attaches to the arterial trunk and the caudal connects to the venous channels.<br />
*The next step after the formation of the heart tube is looping which dictates the position of the ventricle in relationship to the atria. If the heart tube loops to the right (D-loop), the morphologic right ventricle is positioned to the right of the left ventricle. If it loops to the left (L-loop), the morphologic right ventricle is positioned to the left of the left ventricle.<br />
<br />
===Pathogenesis===<br />
*Dextrocardia is a cardiac anomaly in which the major axis of the heart from base to apex points to the right side, in contrast to the normal orientation of the heart where the apex points to the left side. The term dextrocardia outlines the position of the cardiac axis only and not the chamber organisation and structural anatomy of the heart.<ref name="pmid26411880">{{cite journal| author=Ogunlade O, Ayoka AO, Akomolafe RO, Akinsomisoye OS, Irinoye AI, Ajao A | display-authors=etal| title=The role of electrocardiogram in the diagnosis of dextrocardia with mirror image atrial arrangement and ventricular position in a young adult Nigerian in Ile-Ife: a case report. | journal=J Med Case Rep | year= 2015 | volume= 9 | issue= | pages= 222 | pmid=26411880 | doi=10.1186/s13256-015-0695-4 | pmc=4584464 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26411880 }} </ref><ref name="pmid16287744">{{cite journal| author=Bernasconi A, Azancot A, Simpson JM, Jones A, Sharland GK| title=Fetal dextrocardia: diagnosis and outcome in two tertiary centres. | journal=Heart | year= 2005 | volume= 91 | issue= 12 | pages= 1590-4 | pmid=16287744 | doi=10.1136/hrt.2004.048330 | pmc=1769217 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16287744 }} </ref><br />
*The malposition is not as a result of any extracardiac abnormalities but intrinsic to the heart. It is as a result of embryological abnormalities that occur during the development of the heart.<ref name="MaldjianSaric2007">{{cite journal|last1=Maldjian|first1=Pierre D.|last2=Saric|first2=Muhamed|title=Approach to Dextrocardia in Adults:Review|journal=American Journal of Roentgenology|volume=188|issue=6_supplement|year=2007|pages=S39–S49|issn=0361-803X|doi=10.2214/AJR.06.1179}}</ref><br />
*Failure of migration of the D-bulboventricular loop into the left hemithorax can result in dextrocardia with the heart in the right hemithorax. Also, the complete rotation of the L-bulboventricular loop in the right hemithorax can result in the heart situated in the right hemithorax.<br />
*Dextrocardia with a normal abdominal situs has a 90 to 95% chance of associated congenital cardiac anomalies including atrial septal defect, transposition of the great vessels, and ventricular septal defect. It has a lower incidence (0 to 10%) in the presence of situs inversus.<ref name="KumarSingh2014">{{cite journal|last1=Kumar|first1=Abnish|last2=Singh|first2=Manoj Kumar|last3=Yadav|first3=Neeraj|title=Dextrocardia and asplenia in situs inversus totalis in a baby: a case report|journal=Journal of Medical Case Reports|volume=8|issue=1|year=2014|issn=1752-1947|doi=10.1186/1752-1947-8-408}}</ref><br />
<br />
==Genetics==<br />
Genes involved in the pathogenesis of dextrocrdia include:<ref name="FahedGelb2013">{{cite journal|last1=Fahed|first1=Akl C.|last2=Gelb|first2=Bruce D.|last3=Seidman|first3=J. G.|last4=Seidman|first4=Christine E.|title=Genetics of Congenital Heart Disease|journal=Circulation Research|volume=112|issue=4|year=2013|pages=707–720|issn=0009-7330|doi=10.1161/CIRCRESAHA.112.300853}}</ref><br />
*ZIC3<br />
*ACVR2B<br />
*NODAL<br />
<br />
==Associated Conditions==<br />
Conditions associated with [disease name] include:<ref name="pmid27330607">{{cite journal| author=Khoury M, Harbieh B, Heriopian A| title=Isolated dextrocardia and congenital heart blocking. | journal=Radiol Case Rep | year= 2013 | volume= 8 | issue= 1 | pages= 521 | pmid=27330607 | doi=10.2484/rcr.v8i1.521 | pmc=4900208 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27330607 }} </ref><ref name="pmid22605582">{{cite journal| author=Panneerselvam A, Subbiahnadar P| title=Is it dextrocardia or dextroversion? | journal=BMJ Case Rep | year= 2012 | volume= 2012 | issue= | pages= | pmid=22605582 | doi=10.1136/bcr.01.2012.5493 | pmc=3316784 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22605582 }} </ref><ref name="pmid26411880">{{cite journal| author=Ogunlade O, Ayoka AO, Akomolafe RO, Akinsomisoye OS, Irinoye AI, Ajao A | display-authors=etal| title=The role of electrocardiogram in the diagnosis of dextrocardia with mirror image atrial arrangement and ventricular position in a young adult Nigerian in Ile-Ife: a case report. | journal=J Med Case Rep | year= 2015 | volume= 9 | issue= | pages= 222 | pmid=26411880 | doi=10.1186/s13256-015-0695-4 | pmc=4584464 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26411880 }} </ref><ref name="MaldjianSaric2007">{{cite journal|last1=Maldjian|first1=Pierre D.|last2=Saric|first2=Muhamed|title=Approach to Dextrocardia in Adults:Review|journal=American Journal of Roentgenology|volume=188|issue=6_supplement|year=2007|pages=S39–S49|issn=0361-803X|doi=10.2214/AJR.06.1179}}</ref><br />
*Tricuspid atresia<br />
*Transposition of the great vessels<br />
*Pulmonary stenosis<br />
*Double-outlet double-inlet ventricle<br />
*Single ventricle<br />
*Sick sinus syndrome<br />
*Situs inversus<br />
*Situs solitus<br />
*Situs ambiguous<br />
*Kartagener syndrome<br />
*Double-outlet or double-inlet ventricles<br />
<br />
==References==<br />
{{Reflist|2}}<br />
<br />
{{WH}}<br />
{{WS}}<br />
[[Category: (name of the system)]]</div>
Ifeoma odukwe
https://www.wikidoc.org/index.php?title=Dextrocardia_pathophysiology&diff=1608827
Dextrocardia pathophysiology
2020-05-18T19:29:32Z
<p>Ifeoma odukwe: /* Pathogenesis */</p>
<hr />
<div>__NOTOC__<br />
{{Dextrocardia}}<br />
<br />
{{CMG}}; {{AE}} <br />
==Overview==<br />
The exact pathogenesis of [disease name] is not fully understood.<br />
<br />
OR<br />
<br />
It is thought that [disease name] is the result of / is mediated by / is produced by / is caused by either [hypothesis 1], [hypothesis 2], or [hypothesis 3].<br />
<br />
OR<br />
<br />
[Pathogen name] is usually transmitted via the [transmission route] route to the human host.<br />
<br />
OR<br />
<br />
Following transmission/ingestion, the [pathogen] uses the [entry site] to invade the [cell name] cell.<br />
<br />
OR<br />
<br />
<br />
[Disease or malignancy name] arises from [cell name]s, which are [cell type] cells that are normally involved in [function of cells].<br />
<br />
OR<br />
<br />
The progression to [disease name] usually involves the [molecular pathway].<br />
<br />
OR<br />
<br />
The pathophysiology of [disease/malignancy] depends on the histological subtype.<br />
<br />
==Pathophysiology==<br />
===Embryology===<br />
*The fetal heart forms from an embryonic heart tube. The heart tube is formed by fusion of the endocardial tubes. <br />
*The cranial portion of the heart tube attaches to the arterial trunk and the caudal connects to the venous channels.<br />
*The next step after the formation of the heart tube is looping which dictates the position of the ventricle in relationship to the atria. If the heart tube loops to the right (D-loop), the morphologic right ventricle is positioned to the right of the left ventricle. If it loops to the left (L-loop), the morphologic right ventricle is positioned to the left of the left ventricle.<br />
<br />
===Pathogenesis===<br />
*Dextrocardia is a cardiac anomaly in which the major axis of the heart from base to apex points to the right side, in contrast to the normal orientation of the heart where the apex points to the left side. The term dextrocardia outlines the position of the cardiac axis only and not the chamber organisation and structural anatomy of the heart.<ref name="pmid26411880">{{cite journal| author=Ogunlade O, Ayoka AO, Akomolafe RO, Akinsomisoye OS, Irinoye AI, Ajao A | display-authors=etal| title=The role of electrocardiogram in the diagnosis of dextrocardia with mirror image atrial arrangement and ventricular position in a young adult Nigerian in Ile-Ife: a case report. | journal=J Med Case Rep | year= 2015 | volume= 9 | issue= | pages= 222 | pmid=26411880 | doi=10.1186/s13256-015-0695-4 | pmc=4584464 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26411880 }} </ref><ref name="pmid16287744">{{cite journal| author=Bernasconi A, Azancot A, Simpson JM, Jones A, Sharland GK| title=Fetal dextrocardia: diagnosis and outcome in two tertiary centres. | journal=Heart | year= 2005 | volume= 91 | issue= 12 | pages= 1590-4 | pmid=16287744 | doi=10.1136/hrt.2004.048330 | pmc=1769217 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16287744 }} </ref><br />
*The malposition is not as a result of any extracardiac abnormalities but intrinsic to the heart. It is as a result of embryological abnormalities that occur during the development of the heart.<ref name="MaldjianSaric2007">{{cite journal|last1=Maldjian|first1=Pierre D.|last2=Saric|first2=Muhamed|title=Approach to Dextrocardia in Adults:Review|journal=American Journal of Roentgenology|volume=188|issue=6_supplement|year=2007|pages=S39–S49|issn=0361-803X|doi=10.2214/AJR.06.1179}}</ref><br />
*Failure of migration of the D-bulboventricular loop into the left hemithorax can result in dextrocardia with the heart in the right hemithorax. Also, the complete rotation of the L-bulboventricular loop in the right hemithorax can result in the heart situated in the right hemithorax.<br />
*Dextrocardia with a normal abdominal situs has a 90 to 95% chance of associated congenital cardiac anomalies including atrial septal defect, transposition of the great vessels, and ventricular septal defect. It has a lower incidence (0 to 10%) in the presence of situs inversus.<ref name="KumarSingh2014">{{cite journal|last1=Kumar|first1=Abnish|last2=Singh|first2=Manoj Kumar|last3=Yadav|first3=Neeraj|title=Dextrocardia and asplenia in situs inversus totalis in a baby: a case report|journal=Journal of Medical Case Reports|volume=8|issue=1|year=2014|issn=1752-1947|doi=10.1186/1752-1947-8-408}}</ref><br />
<br />
==Genetics==<br />
Genes involved in the pathogenesis of dextrocrdia include:<ref name="FahedGelb2013">{{cite journal|last1=Fahed|first1=Akl C.|last2=Gelb|first2=Bruce D.|last3=Seidman|first3=J. G.|last4=Seidman|first4=Christine E.|title=Genetics of Congenital Heart Disease|journal=Circulation Research|volume=112|issue=4|year=2013|pages=707–720|issn=0009-7330|doi=10.1161/CIRCRESAHA.112.300853}}</ref><br />
*ZIC3<br />
*ACVR2B<br />
*NODAL<br />
<br />
==Associated Conditions==<br />
Conditions associated with [disease name] include:<ref name="pmid27330607">{{cite journal| author=Khoury M, Harbieh B, Heriopian A| title=Isolated dextrocardia and congenital heart blocking. | journal=Radiol Case Rep | year= 2013 | volume= 8 | issue= 1 | pages= 521 | pmid=27330607 | doi=10.2484/rcr.v8i1.521 | pmc=4900208 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27330607 }} </ref><ref name="pmid22605582">{{cite journal| author=Panneerselvam A, Subbiahnadar P| title=Is it dextrocardia or dextroversion? | journal=BMJ Case Rep | year= 2012 | volume= 2012 | issue= | pages= | pmid=22605582 | doi=10.1136/bcr.01.2012.5493 | pmc=3316784 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22605582 }} </ref><ref name="pmid26411880">{{cite journal| author=Ogunlade O, Ayoka AO, Akomolafe RO, Akinsomisoye OS, Irinoye AI, Ajao A | display-authors=etal| title=The role of electrocardiogram in the diagnosis of dextrocardia with mirror image atrial arrangement and ventricular position in a young adult Nigerian in Ile-Ife: a case report. | journal=J Med Case Rep | year= 2015 | volume= 9 | issue= | pages= 222 | pmid=26411880 | doi=10.1186/s13256-015-0695-4 | pmc=4584464 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26411880 }} </ref><ref name="MaldjianSaric2007">{{cite journal|last1=Maldjian|first1=Pierre D.|last2=Saric|first2=Muhamed|title=Approach to Dextrocardia in Adults:Review|journal=American Journal of Roentgenology|volume=188|issue=6_supplement|year=2007|pages=S39–S49|issn=0361-803X|doi=10.2214/AJR.06.1179}}</ref><br />
*Tricuspid atresia<br />
*Transposition of the great vessels<br />
*Pulmonary stenosis<br />
*Double-outlet double-inlet ventricle<br />
*Single ventricle<br />
*Sick sinus syndrome<br />
*Situs inversus<br />
*Situs solitus<br />
*Situs ambiguous<br />
*Kartagener syndrome<br />
*Double-outlet or double-inlet ventricles<br />
<br />
==References==<br />
{{Reflist|2}}<br />
<br />
{{WH}}<br />
{{WS}}<br />
[[Category: (name of the system)]]</div>
Ifeoma odukwe
https://www.wikidoc.org/index.php?title=Dextrocardia_pathophysiology&diff=1608823
Dextrocardia pathophysiology
2020-05-18T19:20:10Z
<p>Ifeoma odukwe: /* Pathogenesis */</p>
<hr />
<div>__NOTOC__<br />
{{Dextrocardia}}<br />
<br />
{{CMG}}; {{AE}} <br />
==Overview==<br />
The exact pathogenesis of [disease name] is not fully understood.<br />
<br />
OR<br />
<br />
It is thought that [disease name] is the result of / is mediated by / is produced by / is caused by either [hypothesis 1], [hypothesis 2], or [hypothesis 3].<br />
<br />
OR<br />
<br />
[Pathogen name] is usually transmitted via the [transmission route] route to the human host.<br />
<br />
OR<br />
<br />
Following transmission/ingestion, the [pathogen] uses the [entry site] to invade the [cell name] cell.<br />
<br />
OR<br />
<br />
<br />
[Disease or malignancy name] arises from [cell name]s, which are [cell type] cells that are normally involved in [function of cells].<br />
<br />
OR<br />
<br />
The progression to [disease name] usually involves the [molecular pathway].<br />
<br />
OR<br />
<br />
The pathophysiology of [disease/malignancy] depends on the histological subtype.<br />
<br />
==Pathophysiology==<br />
===Embryology===<br />
*The fetal heart forms from an embryonic heart tube. The heart tube is formed by fusion of the endocardial tubes. <br />
*The cranial portion of the heart tube attaches to the arterial trunk and the caudal connects to the venous channels.<br />
*The next step after the formation of the heart tube is looping which dictates the position of the ventricle in relationship to the atria. If the heart tube loops to the right (D-loop), the morphologic right ventricle is positioned to the right of the left ventricle. If it loops to the left (L-loop), the morphologic right ventricle is positioned to the left of the left ventricle.<br />
<br />
===Pathogenesis===<br />
*Dextrocardia is a cardiac anomaly in which the major axis of the heart from base to apex points to the right side, in contrast to the normal orientation of the heart where the apex points to the left side. The term dextrocardia outlines the position of the cardiac axis only and not the chamber organisation and structural anatomy of the heart.<ref name="pmid26411880">{{cite journal| author=Ogunlade O, Ayoka AO, Akomolafe RO, Akinsomisoye OS, Irinoye AI, Ajao A | display-authors=etal| title=The role of electrocardiogram in the diagnosis of dextrocardia with mirror image atrial arrangement and ventricular position in a young adult Nigerian in Ile-Ife: a case report. | journal=J Med Case Rep | year= 2015 | volume= 9 | issue= | pages= 222 | pmid=26411880 | doi=10.1186/s13256-015-0695-4 | pmc=4584464 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26411880 }} </ref><ref name="pmid16287744">{{cite journal| author=Bernasconi A, Azancot A, Simpson JM, Jones A, Sharland GK| title=Fetal dextrocardia: diagnosis and outcome in two tertiary centres. | journal=Heart | year= 2005 | volume= 91 | issue= 12 | pages= 1590-4 | pmid=16287744 | doi=10.1136/hrt.2004.048330 | pmc=1769217 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16287744 }} </ref><br />
*The malposition is not as a result of any extracardiac abnormalities but intrinsic to the heart. It is as a result of embryological abnormalities that occur during the development of the heart.<ref name="MaldjianSaric2007">{{cite journal|last1=Maldjian|first1=Pierre D.|last2=Saric|first2=Muhamed|title=Approach to Dextrocardia in Adults:Review|journal=American Journal of Roentgenology|volume=188|issue=6_supplement|year=2007|pages=S39–S49|issn=0361-803X|doi=10.2214/AJR.06.1179}}</ref><br />
*Failure of migration of the D-bulboventricular loop into the left hemithorax can result in dextrocardia with the heart in the right hemithorax.<br />
*Dextrocardia with a normal abdominal situs has a 90 to 95% chance of associated congenital cardiac anomalies including atrial septal defect, transposition of the great vessels, and ventricular septal defect. It has a lower incidence (0 to 10%) in the presence of situs inversus.<ref name="KumarSingh2014">{{cite journal|last1=Kumar|first1=Abnish|last2=Singh|first2=Manoj Kumar|last3=Yadav|first3=Neeraj|title=Dextrocardia and asplenia in situs inversus totalis in a baby: a case report|journal=Journal of Medical Case Reports|volume=8|issue=1|year=2014|issn=1752-1947|doi=10.1186/1752-1947-8-408}}</ref><br />
<br />
==Genetics==<br />
Genes involved in the pathogenesis of dextrocrdia include:<ref name="FahedGelb2013">{{cite journal|last1=Fahed|first1=Akl C.|last2=Gelb|first2=Bruce D.|last3=Seidman|first3=J. G.|last4=Seidman|first4=Christine E.|title=Genetics of Congenital Heart Disease|journal=Circulation Research|volume=112|issue=4|year=2013|pages=707–720|issn=0009-7330|doi=10.1161/CIRCRESAHA.112.300853}}</ref><br />
*ZIC3<br />
*ACVR2B<br />
*NODAL<br />
<br />
==Associated Conditions==<br />
Conditions associated with [disease name] include:<ref name="pmid27330607">{{cite journal| author=Khoury M, Harbieh B, Heriopian A| title=Isolated dextrocardia and congenital heart blocking. | journal=Radiol Case Rep | year= 2013 | volume= 8 | issue= 1 | pages= 521 | pmid=27330607 | doi=10.2484/rcr.v8i1.521 | pmc=4900208 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27330607 }} </ref><ref name="pmid22605582">{{cite journal| author=Panneerselvam A, Subbiahnadar P| title=Is it dextrocardia or dextroversion? | journal=BMJ Case Rep | year= 2012 | volume= 2012 | issue= | pages= | pmid=22605582 | doi=10.1136/bcr.01.2012.5493 | pmc=3316784 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22605582 }} </ref><ref name="pmid26411880">{{cite journal| author=Ogunlade O, Ayoka AO, Akomolafe RO, Akinsomisoye OS, Irinoye AI, Ajao A | display-authors=etal| title=The role of electrocardiogram in the diagnosis of dextrocardia with mirror image atrial arrangement and ventricular position in a young adult Nigerian in Ile-Ife: a case report. | journal=J Med Case Rep | year= 2015 | volume= 9 | issue= | pages= 222 | pmid=26411880 | doi=10.1186/s13256-015-0695-4 | pmc=4584464 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26411880 }} </ref><ref name="MaldjianSaric2007">{{cite journal|last1=Maldjian|first1=Pierre D.|last2=Saric|first2=Muhamed|title=Approach to Dextrocardia in Adults:Review|journal=American Journal of Roentgenology|volume=188|issue=6_supplement|year=2007|pages=S39–S49|issn=0361-803X|doi=10.2214/AJR.06.1179}}</ref><br />
*Tricuspid atresia<br />
*Transposition of the great vessels<br />
*Pulmonary stenosis<br />
*Double-outlet double-inlet ventricle<br />
*Single ventricle<br />
*Sick sinus syndrome<br />
*Situs inversus<br />
*Situs solitus<br />
*Situs ambiguous<br />
*Kartagener syndrome<br />
*Double-outlet or double-inlet ventricles<br />
<br />
==References==<br />
{{Reflist|2}}<br />
<br />
{{WH}}<br />
{{WS}}<br />
[[Category: (name of the system)]]</div>
Ifeoma odukwe
https://www.wikidoc.org/index.php?title=Dextrocardia_pathophysiology&diff=1608820
Dextrocardia pathophysiology
2020-05-18T18:14:30Z
<p>Ifeoma odukwe: /* Embryology */</p>
<hr />
<div>__NOTOC__<br />
{{Dextrocardia}}<br />
<br />
{{CMG}}; {{AE}} <br />
==Overview==<br />
The exact pathogenesis of [disease name] is not fully understood.<br />
<br />
OR<br />
<br />
It is thought that [disease name] is the result of / is mediated by / is produced by / is caused by either [hypothesis 1], [hypothesis 2], or [hypothesis 3].<br />
<br />
OR<br />
<br />
[Pathogen name] is usually transmitted via the [transmission route] route to the human host.<br />
<br />
OR<br />
<br />
Following transmission/ingestion, the [pathogen] uses the [entry site] to invade the [cell name] cell.<br />
<br />
OR<br />
<br />
<br />
[Disease or malignancy name] arises from [cell name]s, which are [cell type] cells that are normally involved in [function of cells].<br />
<br />
OR<br />
<br />
The progression to [disease name] usually involves the [molecular pathway].<br />
<br />
OR<br />
<br />
The pathophysiology of [disease/malignancy] depends on the histological subtype.<br />
<br />
==Pathophysiology==<br />
===Embryology===<br />
*The fetal heart forms from an embryonic heart tube. The heart tube is formed by fusion of the endocardial tubes. <br />
*The cranial portion of the heart tube attaches to the arterial trunk and the caudal connects to the venous channels.<br />
*The next step after the formation of the heart tube is looping which dictates the position of the ventricle in relationship to the atria. If the heart tube loops to the right (D-loop), the morphologic right ventricle is positioned to the right of the left ventricle. If it loops to the left (L-loop), the morphologic right ventricle is positioned to the left of the left ventricle.<br />
<br />
===Pathogenesis===<br />
*Dextrocardia is a cardiac anomaly in which the major axis of the heart from base to apex points to the right side, in contrast to the normal orientation of the heart where the apex points to the left side. The term dextrocardia outlines the position of the cardiac axis only and not the chamber organisation and structural anatomy of the heart.<ref name="pmid26411880">{{cite journal| author=Ogunlade O, Ayoka AO, Akomolafe RO, Akinsomisoye OS, Irinoye AI, Ajao A | display-authors=etal| title=The role of electrocardiogram in the diagnosis of dextrocardia with mirror image atrial arrangement and ventricular position in a young adult Nigerian in Ile-Ife: a case report. | journal=J Med Case Rep | year= 2015 | volume= 9 | issue= | pages= 222 | pmid=26411880 | doi=10.1186/s13256-015-0695-4 | pmc=4584464 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26411880 }} </ref><ref name="pmid16287744">{{cite journal| author=Bernasconi A, Azancot A, Simpson JM, Jones A, Sharland GK| title=Fetal dextrocardia: diagnosis and outcome in two tertiary centres. | journal=Heart | year= 2005 | volume= 91 | issue= 12 | pages= 1590-4 | pmid=16287744 | doi=10.1136/hrt.2004.048330 | pmc=1769217 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16287744 }} </ref><br />
*The malposition is not as a result of any extracardiac abnormalities but intrinsic to the heart. It is as a result of embryological abnormalities that occur during the development of the heart.<ref name="MaldjianSaric2007">{{cite journal|last1=Maldjian|first1=Pierre D.|last2=Saric|first2=Muhamed|title=Approach to Dextrocardia in Adults:Review|journal=American Journal of Roentgenology|volume=188|issue=6_supplement|year=2007|pages=S39–S49|issn=0361-803X|doi=10.2214/AJR.06.1179}}</ref><br />
*Dextrocardia with a normal abdominal situs has a 90 to 95% chance of associated congenital cardiac anomalies including atrial septal defect, transposition of the great vessels, and ventricular septal defect. It has a lower incidence (0 to 10%) in the presence of situs inversus.<ref name="KumarSingh2014">{{cite journal|last1=Kumar|first1=Abnish|last2=Singh|first2=Manoj Kumar|last3=Yadav|first3=Neeraj|title=Dextrocardia and asplenia in situs inversus totalis in a baby: a case report|journal=Journal of Medical Case Reports|volume=8|issue=1|year=2014|issn=1752-1947|doi=10.1186/1752-1947-8-408}}</ref><br />
<br />
==Genetics==<br />
Genes involved in the pathogenesis of dextrocrdia include:<ref name="FahedGelb2013">{{cite journal|last1=Fahed|first1=Akl C.|last2=Gelb|first2=Bruce D.|last3=Seidman|first3=J. G.|last4=Seidman|first4=Christine E.|title=Genetics of Congenital Heart Disease|journal=Circulation Research|volume=112|issue=4|year=2013|pages=707–720|issn=0009-7330|doi=10.1161/CIRCRESAHA.112.300853}}</ref><br />
*ZIC3<br />
*ACVR2B<br />
*NODAL<br />
<br />
==Associated Conditions==<br />
Conditions associated with [disease name] include:<ref name="pmid27330607">{{cite journal| author=Khoury M, Harbieh B, Heriopian A| title=Isolated dextrocardia and congenital heart blocking. | journal=Radiol Case Rep | year= 2013 | volume= 8 | issue= 1 | pages= 521 | pmid=27330607 | doi=10.2484/rcr.v8i1.521 | pmc=4900208 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27330607 }} </ref><ref name="pmid22605582">{{cite journal| author=Panneerselvam A, Subbiahnadar P| title=Is it dextrocardia or dextroversion? | journal=BMJ Case Rep | year= 2012 | volume= 2012 | issue= | pages= | pmid=22605582 | doi=10.1136/bcr.01.2012.5493 | pmc=3316784 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22605582 }} </ref><ref name="pmid26411880">{{cite journal| author=Ogunlade O, Ayoka AO, Akomolafe RO, Akinsomisoye OS, Irinoye AI, Ajao A | display-authors=etal| title=The role of electrocardiogram in the diagnosis of dextrocardia with mirror image atrial arrangement and ventricular position in a young adult Nigerian in Ile-Ife: a case report. | journal=J Med Case Rep | year= 2015 | volume= 9 | issue= | pages= 222 | pmid=26411880 | doi=10.1186/s13256-015-0695-4 | pmc=4584464 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26411880 }} </ref><ref name="MaldjianSaric2007">{{cite journal|last1=Maldjian|first1=Pierre D.|last2=Saric|first2=Muhamed|title=Approach to Dextrocardia in Adults:Review|journal=American Journal of Roentgenology|volume=188|issue=6_supplement|year=2007|pages=S39–S49|issn=0361-803X|doi=10.2214/AJR.06.1179}}</ref><br />
*Tricuspid atresia<br />
*Transposition of the great vessels<br />
*Pulmonary stenosis<br />
*Double-outlet double-inlet ventricle<br />
*Single ventricle<br />
*Sick sinus syndrome<br />
*Situs inversus<br />
*Situs solitus<br />
*Situs ambiguous<br />
*Kartagener syndrome<br />
*Double-outlet or double-inlet ventricles<br />
<br />
==References==<br />
{{Reflist|2}}<br />
<br />
{{WH}}<br />
{{WS}}<br />
[[Category: (name of the system)]]</div>
Ifeoma odukwe
https://www.wikidoc.org/index.php?title=Dextrocardia_pathophysiology&diff=1608819
Dextrocardia pathophysiology
2020-05-18T18:13:14Z
<p>Ifeoma odukwe: /* Embryology */</p>
<hr />
<div>__NOTOC__<br />
{{Dextrocardia}}<br />
<br />
{{CMG}}; {{AE}} <br />
==Overview==<br />
The exact pathogenesis of [disease name] is not fully understood.<br />
<br />
OR<br />
<br />
It is thought that [disease name] is the result of / is mediated by / is produced by / is caused by either [hypothesis 1], [hypothesis 2], or [hypothesis 3].<br />
<br />
OR<br />
<br />
[Pathogen name] is usually transmitted via the [transmission route] route to the human host.<br />
<br />
OR<br />
<br />
Following transmission/ingestion, the [pathogen] uses the [entry site] to invade the [cell name] cell.<br />
<br />
OR<br />
<br />
<br />
[Disease or malignancy name] arises from [cell name]s, which are [cell type] cells that are normally involved in [function of cells].<br />
<br />
OR<br />
<br />
The progression to [disease name] usually involves the [molecular pathway].<br />
<br />
OR<br />
<br />
The pathophysiology of [disease/malignancy] depends on the histological subtype.<br />
<br />
==Pathophysiology==<br />
===Embryology===<br />
*The fetal heart forms from an embryonic heart tube. The heart tube is formed by fusion of the endocardial tubes. <br />
*The cranial portion of the heart tube attaches to the arterial trunk and the caudal connects to the venous channels.<br />
*The next step after the formation of the heart tube is looping which dictates the position of the ventricle in relationship to the atria. If the heart tube loops to the right (D-loop), the morphologic right ventricle is positioned to the right of the left ventricle.<br />
<br />
===Pathogenesis===<br />
*Dextrocardia is a cardiac anomaly in which the major axis of the heart from base to apex points to the right side, in contrast to the normal orientation of the heart where the apex points to the left side. The term dextrocardia outlines the position of the cardiac axis only and not the chamber organisation and structural anatomy of the heart.<ref name="pmid26411880">{{cite journal| author=Ogunlade O, Ayoka AO, Akomolafe RO, Akinsomisoye OS, Irinoye AI, Ajao A | display-authors=etal| title=The role of electrocardiogram in the diagnosis of dextrocardia with mirror image atrial arrangement and ventricular position in a young adult Nigerian in Ile-Ife: a case report. | journal=J Med Case Rep | year= 2015 | volume= 9 | issue= | pages= 222 | pmid=26411880 | doi=10.1186/s13256-015-0695-4 | pmc=4584464 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26411880 }} </ref><ref name="pmid16287744">{{cite journal| author=Bernasconi A, Azancot A, Simpson JM, Jones A, Sharland GK| title=Fetal dextrocardia: diagnosis and outcome in two tertiary centres. | journal=Heart | year= 2005 | volume= 91 | issue= 12 | pages= 1590-4 | pmid=16287744 | doi=10.1136/hrt.2004.048330 | pmc=1769217 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16287744 }} </ref><br />
*The malposition is not as a result of any extracardiac abnormalities but intrinsic to the heart. It is as a result of embryological abnormalities that occur during the development of the heart.<ref name="MaldjianSaric2007">{{cite journal|last1=Maldjian|first1=Pierre D.|last2=Saric|first2=Muhamed|title=Approach to Dextrocardia in Adults:Review|journal=American Journal of Roentgenology|volume=188|issue=6_supplement|year=2007|pages=S39–S49|issn=0361-803X|doi=10.2214/AJR.06.1179}}</ref><br />
*Dextrocardia with a normal abdominal situs has a 90 to 95% chance of associated congenital cardiac anomalies including atrial septal defect, transposition of the great vessels, and ventricular septal defect. It has a lower incidence (0 to 10%) in the presence of situs inversus.<ref name="KumarSingh2014">{{cite journal|last1=Kumar|first1=Abnish|last2=Singh|first2=Manoj Kumar|last3=Yadav|first3=Neeraj|title=Dextrocardia and asplenia in situs inversus totalis in a baby: a case report|journal=Journal of Medical Case Reports|volume=8|issue=1|year=2014|issn=1752-1947|doi=10.1186/1752-1947-8-408}}</ref><br />
<br />
==Genetics==<br />
Genes involved in the pathogenesis of dextrocrdia include:<ref name="FahedGelb2013">{{cite journal|last1=Fahed|first1=Akl C.|last2=Gelb|first2=Bruce D.|last3=Seidman|first3=J. G.|last4=Seidman|first4=Christine E.|title=Genetics of Congenital Heart Disease|journal=Circulation Research|volume=112|issue=4|year=2013|pages=707–720|issn=0009-7330|doi=10.1161/CIRCRESAHA.112.300853}}</ref><br />
*ZIC3<br />
*ACVR2B<br />
*NODAL<br />
<br />
==Associated Conditions==<br />
Conditions associated with [disease name] include:<ref name="pmid27330607">{{cite journal| author=Khoury M, Harbieh B, Heriopian A| title=Isolated dextrocardia and congenital heart blocking. | journal=Radiol Case Rep | year= 2013 | volume= 8 | issue= 1 | pages= 521 | pmid=27330607 | doi=10.2484/rcr.v8i1.521 | pmc=4900208 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27330607 }} </ref><ref name="pmid22605582">{{cite journal| author=Panneerselvam A, Subbiahnadar P| title=Is it dextrocardia or dextroversion? | journal=BMJ Case Rep | year= 2012 | volume= 2012 | issue= | pages= | pmid=22605582 | doi=10.1136/bcr.01.2012.5493 | pmc=3316784 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22605582 }} </ref><ref name="pmid26411880">{{cite journal| author=Ogunlade O, Ayoka AO, Akomolafe RO, Akinsomisoye OS, Irinoye AI, Ajao A | display-authors=etal| title=The role of electrocardiogram in the diagnosis of dextrocardia with mirror image atrial arrangement and ventricular position in a young adult Nigerian in Ile-Ife: a case report. | journal=J Med Case Rep | year= 2015 | volume= 9 | issue= | pages= 222 | pmid=26411880 | doi=10.1186/s13256-015-0695-4 | pmc=4584464 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26411880 }} </ref><ref name="MaldjianSaric2007">{{cite journal|last1=Maldjian|first1=Pierre D.|last2=Saric|first2=Muhamed|title=Approach to Dextrocardia in Adults:Review|journal=American Journal of Roentgenology|volume=188|issue=6_supplement|year=2007|pages=S39–S49|issn=0361-803X|doi=10.2214/AJR.06.1179}}</ref><br />
*Tricuspid atresia<br />
*Transposition of the great vessels<br />
*Pulmonary stenosis<br />
*Double-outlet double-inlet ventricle<br />
*Single ventricle<br />
*Sick sinus syndrome<br />
*Situs inversus<br />
*Situs solitus<br />
*Situs ambiguous<br />
*Kartagener syndrome<br />
*Double-outlet or double-inlet ventricles<br />
<br />
==References==<br />
{{Reflist|2}}<br />
<br />
{{WH}}<br />
{{WS}}<br />
[[Category: (name of the system)]]</div>
Ifeoma odukwe
https://www.wikidoc.org/index.php?title=Dextrocardia_pathophysiology&diff=1608817
Dextrocardia pathophysiology
2020-05-18T17:59:06Z
<p>Ifeoma odukwe: /* Embryology */</p>
<hr />
<div>__NOTOC__<br />
{{Dextrocardia}}<br />
<br />
{{CMG}}; {{AE}} <br />
==Overview==<br />
The exact pathogenesis of [disease name] is not fully understood.<br />
<br />
OR<br />
<br />
It is thought that [disease name] is the result of / is mediated by / is produced by / is caused by either [hypothesis 1], [hypothesis 2], or [hypothesis 3].<br />
<br />
OR<br />
<br />
[Pathogen name] is usually transmitted via the [transmission route] route to the human host.<br />
<br />
OR<br />
<br />
Following transmission/ingestion, the [pathogen] uses the [entry site] to invade the [cell name] cell.<br />
<br />
OR<br />
<br />
<br />
[Disease or malignancy name] arises from [cell name]s, which are [cell type] cells that are normally involved in [function of cells].<br />
<br />
OR<br />
<br />
The progression to [disease name] usually involves the [molecular pathway].<br />
<br />
OR<br />
<br />
The pathophysiology of [disease/malignancy] depends on the histological subtype.<br />
<br />
==Pathophysiology==<br />
===Embryology===<br />
*The fetal heart forms from an embryonic heart tube. The heart tube is formed by fusion of the endocardial tubes. <br />
*The cranial portion of the heart tube attaches to the arterial trunk and the caudal connects to the venous channels.<br />
*The next step after the formation of the heart tube is looping which dictates the position of the ventricle in relationship to the atria.<br />
<br />
===Pathogenesis===<br />
*Dextrocardia is a cardiac anomaly in which the major axis of the heart from base to apex points to the right side, in contrast to the normal orientation of the heart where the apex points to the left side. The term dextrocardia outlines the position of the cardiac axis only and not the chamber organisation and structural anatomy of the heart.<ref name="pmid26411880">{{cite journal| author=Ogunlade O, Ayoka AO, Akomolafe RO, Akinsomisoye OS, Irinoye AI, Ajao A | display-authors=etal| title=The role of electrocardiogram in the diagnosis of dextrocardia with mirror image atrial arrangement and ventricular position in a young adult Nigerian in Ile-Ife: a case report. | journal=J Med Case Rep | year= 2015 | volume= 9 | issue= | pages= 222 | pmid=26411880 | doi=10.1186/s13256-015-0695-4 | pmc=4584464 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26411880 }} </ref><ref name="pmid16287744">{{cite journal| author=Bernasconi A, Azancot A, Simpson JM, Jones A, Sharland GK| title=Fetal dextrocardia: diagnosis and outcome in two tertiary centres. | journal=Heart | year= 2005 | volume= 91 | issue= 12 | pages= 1590-4 | pmid=16287744 | doi=10.1136/hrt.2004.048330 | pmc=1769217 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16287744 }} </ref><br />
*The malposition is not as a result of any extracardiac abnormalities but intrinsic to the heart. It is as a result of embryological abnormalities that occur during the development of the heart.<ref name="MaldjianSaric2007">{{cite journal|last1=Maldjian|first1=Pierre D.|last2=Saric|first2=Muhamed|title=Approach to Dextrocardia in Adults:Review|journal=American Journal of Roentgenology|volume=188|issue=6_supplement|year=2007|pages=S39–S49|issn=0361-803X|doi=10.2214/AJR.06.1179}}</ref><br />
*Dextrocardia with a normal abdominal situs has a 90 to 95% chance of associated congenital cardiac anomalies including atrial septal defect, transposition of the great vessels, and ventricular septal defect. It has a lower incidence (0 to 10%) in the presence of situs inversus.<ref name="KumarSingh2014">{{cite journal|last1=Kumar|first1=Abnish|last2=Singh|first2=Manoj Kumar|last3=Yadav|first3=Neeraj|title=Dextrocardia and asplenia in situs inversus totalis in a baby: a case report|journal=Journal of Medical Case Reports|volume=8|issue=1|year=2014|issn=1752-1947|doi=10.1186/1752-1947-8-408}}</ref><br />
<br />
==Genetics==<br />
Genes involved in the pathogenesis of dextrocrdia include:<ref name="FahedGelb2013">{{cite journal|last1=Fahed|first1=Akl C.|last2=Gelb|first2=Bruce D.|last3=Seidman|first3=J. G.|last4=Seidman|first4=Christine E.|title=Genetics of Congenital Heart Disease|journal=Circulation Research|volume=112|issue=4|year=2013|pages=707–720|issn=0009-7330|doi=10.1161/CIRCRESAHA.112.300853}}</ref><br />
*ZIC3<br />
*ACVR2B<br />
*NODAL<br />
<br />
==Associated Conditions==<br />
Conditions associated with [disease name] include:<ref name="pmid27330607">{{cite journal| author=Khoury M, Harbieh B, Heriopian A| title=Isolated dextrocardia and congenital heart blocking. | journal=Radiol Case Rep | year= 2013 | volume= 8 | issue= 1 | pages= 521 | pmid=27330607 | doi=10.2484/rcr.v8i1.521 | pmc=4900208 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27330607 }} </ref><ref name="pmid22605582">{{cite journal| author=Panneerselvam A, Subbiahnadar P| title=Is it dextrocardia or dextroversion? | journal=BMJ Case Rep | year= 2012 | volume= 2012 | issue= | pages= | pmid=22605582 | doi=10.1136/bcr.01.2012.5493 | pmc=3316784 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22605582 }} </ref><ref name="pmid26411880">{{cite journal| author=Ogunlade O, Ayoka AO, Akomolafe RO, Akinsomisoye OS, Irinoye AI, Ajao A | display-authors=etal| title=The role of electrocardiogram in the diagnosis of dextrocardia with mirror image atrial arrangement and ventricular position in a young adult Nigerian in Ile-Ife: a case report. | journal=J Med Case Rep | year= 2015 | volume= 9 | issue= | pages= 222 | pmid=26411880 | doi=10.1186/s13256-015-0695-4 | pmc=4584464 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26411880 }} </ref><ref name="MaldjianSaric2007">{{cite journal|last1=Maldjian|first1=Pierre D.|last2=Saric|first2=Muhamed|title=Approach to Dextrocardia in Adults:Review|journal=American Journal of Roentgenology|volume=188|issue=6_supplement|year=2007|pages=S39–S49|issn=0361-803X|doi=10.2214/AJR.06.1179}}</ref><br />
*Tricuspid atresia<br />
*Transposition of the great vessels<br />
*Pulmonary stenosis<br />
*Double-outlet double-inlet ventricle<br />
*Single ventricle<br />
*Sick sinus syndrome<br />
*Situs inversus<br />
*Situs solitus<br />
*Situs ambiguous<br />
*Kartagener syndrome<br />
*Double-outlet or double-inlet ventricles<br />
<br />
==References==<br />
{{Reflist|2}}<br />
<br />
{{WH}}<br />
{{WS}}<br />
[[Category: (name of the system)]]</div>
Ifeoma odukwe
https://www.wikidoc.org/index.php?title=Dextrocardia_pathophysiology&diff=1608815
Dextrocardia pathophysiology
2020-05-18T17:56:18Z
<p>Ifeoma odukwe: /* Embryology */</p>
<hr />
<div>__NOTOC__<br />
{{Dextrocardia}}<br />
<br />
{{CMG}}; {{AE}} <br />
==Overview==<br />
The exact pathogenesis of [disease name] is not fully understood.<br />
<br />
OR<br />
<br />
It is thought that [disease name] is the result of / is mediated by / is produced by / is caused by either [hypothesis 1], [hypothesis 2], or [hypothesis 3].<br />
<br />
OR<br />
<br />
[Pathogen name] is usually transmitted via the [transmission route] route to the human host.<br />
<br />
OR<br />
<br />
Following transmission/ingestion, the [pathogen] uses the [entry site] to invade the [cell name] cell.<br />
<br />
OR<br />
<br />
<br />
[Disease or malignancy name] arises from [cell name]s, which are [cell type] cells that are normally involved in [function of cells].<br />
<br />
OR<br />
<br />
The progression to [disease name] usually involves the [molecular pathway].<br />
<br />
OR<br />
<br />
The pathophysiology of [disease/malignancy] depends on the histological subtype.<br />
<br />
==Pathophysiology==<br />
===Embryology===<br />
*The fetal heart forms from an embryonic heart tube. The heart tube is formed by fusion of the endocardial tubes. <br />
*The cranial portion of the heart tube attaches to the arterial trunk and the caudal connects to the venous channels.<br />
*The next step after the formation of the heart tube is looping.<br />
<br />
===Pathogenesis===<br />
*Dextrocardia is a cardiac anomaly in which the major axis of the heart from base to apex points to the right side, in contrast to the normal orientation of the heart where the apex points to the left side. The term dextrocardia outlines the position of the cardiac axis only and not the chamber organisation and structural anatomy of the heart.<ref name="pmid26411880">{{cite journal| author=Ogunlade O, Ayoka AO, Akomolafe RO, Akinsomisoye OS, Irinoye AI, Ajao A | display-authors=etal| title=The role of electrocardiogram in the diagnosis of dextrocardia with mirror image atrial arrangement and ventricular position in a young adult Nigerian in Ile-Ife: a case report. | journal=J Med Case Rep | year= 2015 | volume= 9 | issue= | pages= 222 | pmid=26411880 | doi=10.1186/s13256-015-0695-4 | pmc=4584464 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26411880 }} </ref><ref name="pmid16287744">{{cite journal| author=Bernasconi A, Azancot A, Simpson JM, Jones A, Sharland GK| title=Fetal dextrocardia: diagnosis and outcome in two tertiary centres. | journal=Heart | year= 2005 | volume= 91 | issue= 12 | pages= 1590-4 | pmid=16287744 | doi=10.1136/hrt.2004.048330 | pmc=1769217 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16287744 }} </ref><br />
*The malposition is not as a result of any extracardiac abnormalities but intrinsic to the heart. It is as a result of embryological abnormalities that occur during the development of the heart.<ref name="MaldjianSaric2007">{{cite journal|last1=Maldjian|first1=Pierre D.|last2=Saric|first2=Muhamed|title=Approach to Dextrocardia in Adults:Review|journal=American Journal of Roentgenology|volume=188|issue=6_supplement|year=2007|pages=S39–S49|issn=0361-803X|doi=10.2214/AJR.06.1179}}</ref><br />
*Dextrocardia with a normal abdominal situs has a 90 to 95% chance of associated congenital cardiac anomalies including atrial septal defect, transposition of the great vessels, and ventricular septal defect. It has a lower incidence (0 to 10%) in the presence of situs inversus.<ref name="KumarSingh2014">{{cite journal|last1=Kumar|first1=Abnish|last2=Singh|first2=Manoj Kumar|last3=Yadav|first3=Neeraj|title=Dextrocardia and asplenia in situs inversus totalis in a baby: a case report|journal=Journal of Medical Case Reports|volume=8|issue=1|year=2014|issn=1752-1947|doi=10.1186/1752-1947-8-408}}</ref><br />
<br />
==Genetics==<br />
Genes involved in the pathogenesis of dextrocrdia include:<ref name="FahedGelb2013">{{cite journal|last1=Fahed|first1=Akl C.|last2=Gelb|first2=Bruce D.|last3=Seidman|first3=J. G.|last4=Seidman|first4=Christine E.|title=Genetics of Congenital Heart Disease|journal=Circulation Research|volume=112|issue=4|year=2013|pages=707–720|issn=0009-7330|doi=10.1161/CIRCRESAHA.112.300853}}</ref><br />
*ZIC3<br />
*ACVR2B<br />
*NODAL<br />
<br />
==Associated Conditions==<br />
Conditions associated with [disease name] include:<ref name="pmid27330607">{{cite journal| author=Khoury M, Harbieh B, Heriopian A| title=Isolated dextrocardia and congenital heart blocking. | journal=Radiol Case Rep | year= 2013 | volume= 8 | issue= 1 | pages= 521 | pmid=27330607 | doi=10.2484/rcr.v8i1.521 | pmc=4900208 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27330607 }} </ref><ref name="pmid22605582">{{cite journal| author=Panneerselvam A, Subbiahnadar P| title=Is it dextrocardia or dextroversion? | journal=BMJ Case Rep | year= 2012 | volume= 2012 | issue= | pages= | pmid=22605582 | doi=10.1136/bcr.01.2012.5493 | pmc=3316784 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22605582 }} </ref><ref name="pmid26411880">{{cite journal| author=Ogunlade O, Ayoka AO, Akomolafe RO, Akinsomisoye OS, Irinoye AI, Ajao A | display-authors=etal| title=The role of electrocardiogram in the diagnosis of dextrocardia with mirror image atrial arrangement and ventricular position in a young adult Nigerian in Ile-Ife: a case report. | journal=J Med Case Rep | year= 2015 | volume= 9 | issue= | pages= 222 | pmid=26411880 | doi=10.1186/s13256-015-0695-4 | pmc=4584464 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26411880 }} </ref><ref name="MaldjianSaric2007">{{cite journal|last1=Maldjian|first1=Pierre D.|last2=Saric|first2=Muhamed|title=Approach to Dextrocardia in Adults:Review|journal=American Journal of Roentgenology|volume=188|issue=6_supplement|year=2007|pages=S39–S49|issn=0361-803X|doi=10.2214/AJR.06.1179}}</ref><br />
*Tricuspid atresia<br />
*Transposition of the great vessels<br />
*Pulmonary stenosis<br />
*Double-outlet double-inlet ventricle<br />
*Single ventricle<br />
*Sick sinus syndrome<br />
*Situs inversus<br />
*Situs solitus<br />
*Situs ambiguous<br />
*Kartagener syndrome<br />
*Double-outlet or double-inlet ventricles<br />
<br />
==References==<br />
{{Reflist|2}}<br />
<br />
{{WH}}<br />
{{WS}}<br />
[[Category: (name of the system)]]</div>
Ifeoma odukwe
https://www.wikidoc.org/index.php?title=Dextrocardia_pathophysiology&diff=1608814
Dextrocardia pathophysiology
2020-05-18T17:50:00Z
<p>Ifeoma odukwe: /* Embryology */</p>
<hr />
<div>__NOTOC__<br />
{{Dextrocardia}}<br />
<br />
{{CMG}}; {{AE}} <br />
==Overview==<br />
The exact pathogenesis of [disease name] is not fully understood.<br />
<br />
OR<br />
<br />
It is thought that [disease name] is the result of / is mediated by / is produced by / is caused by either [hypothesis 1], [hypothesis 2], or [hypothesis 3].<br />
<br />
OR<br />
<br />
[Pathogen name] is usually transmitted via the [transmission route] route to the human host.<br />
<br />
OR<br />
<br />
Following transmission/ingestion, the [pathogen] uses the [entry site] to invade the [cell name] cell.<br />
<br />
OR<br />
<br />
<br />
[Disease or malignancy name] arises from [cell name]s, which are [cell type] cells that are normally involved in [function of cells].<br />
<br />
OR<br />
<br />
The progression to [disease name] usually involves the [molecular pathway].<br />
<br />
OR<br />
<br />
The pathophysiology of [disease/malignancy] depends on the histological subtype.<br />
<br />
==Pathophysiology==<br />
===Embryology===<br />
*The fetal heart forms from an embryonic heart tube.<br />
*The cranial portion of the heart tube attaches to the arterial trunk and the caudal connects to the venous channels.<br />
<br />
===Pathogenesis===<br />
*Dextrocardia is a cardiac anomaly in which the major axis of the heart from base to apex points to the right side, in contrast to the normal orientation of the heart where the apex points to the left side. The term dextrocardia outlines the position of the cardiac axis only and not the chamber organisation and structural anatomy of the heart.<ref name="pmid26411880">{{cite journal| author=Ogunlade O, Ayoka AO, Akomolafe RO, Akinsomisoye OS, Irinoye AI, Ajao A | display-authors=etal| title=The role of electrocardiogram in the diagnosis of dextrocardia with mirror image atrial arrangement and ventricular position in a young adult Nigerian in Ile-Ife: a case report. | journal=J Med Case Rep | year= 2015 | volume= 9 | issue= | pages= 222 | pmid=26411880 | doi=10.1186/s13256-015-0695-4 | pmc=4584464 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26411880 }} </ref><ref name="pmid16287744">{{cite journal| author=Bernasconi A, Azancot A, Simpson JM, Jones A, Sharland GK| title=Fetal dextrocardia: diagnosis and outcome in two tertiary centres. | journal=Heart | year= 2005 | volume= 91 | issue= 12 | pages= 1590-4 | pmid=16287744 | doi=10.1136/hrt.2004.048330 | pmc=1769217 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16287744 }} </ref><br />
*The malposition is not as a result of any extracardiac abnormalities but intrinsic to the heart. It is as a result of embryological abnormalities that occur during the development of the heart.<ref name="MaldjianSaric2007">{{cite journal|last1=Maldjian|first1=Pierre D.|last2=Saric|first2=Muhamed|title=Approach to Dextrocardia in Adults:Review|journal=American Journal of Roentgenology|volume=188|issue=6_supplement|year=2007|pages=S39–S49|issn=0361-803X|doi=10.2214/AJR.06.1179}}</ref><br />
*Dextrocardia with a normal abdominal situs has a 90 to 95% chance of associated congenital cardiac anomalies including atrial septal defect, transposition of the great vessels, and ventricular septal defect. It has a lower incidence (0 to 10%) in the presence of situs inversus.<ref name="KumarSingh2014">{{cite journal|last1=Kumar|first1=Abnish|last2=Singh|first2=Manoj Kumar|last3=Yadav|first3=Neeraj|title=Dextrocardia and asplenia in situs inversus totalis in a baby: a case report|journal=Journal of Medical Case Reports|volume=8|issue=1|year=2014|issn=1752-1947|doi=10.1186/1752-1947-8-408}}</ref><br />
<br />
==Genetics==<br />
Genes involved in the pathogenesis of dextrocrdia include:<ref name="FahedGelb2013">{{cite journal|last1=Fahed|first1=Akl C.|last2=Gelb|first2=Bruce D.|last3=Seidman|first3=J. G.|last4=Seidman|first4=Christine E.|title=Genetics of Congenital Heart Disease|journal=Circulation Research|volume=112|issue=4|year=2013|pages=707–720|issn=0009-7330|doi=10.1161/CIRCRESAHA.112.300853}}</ref><br />
*ZIC3<br />
*ACVR2B<br />
*NODAL<br />
<br />
==Associated Conditions==<br />
Conditions associated with [disease name] include:<ref name="pmid27330607">{{cite journal| author=Khoury M, Harbieh B, Heriopian A| title=Isolated dextrocardia and congenital heart blocking. | journal=Radiol Case Rep | year= 2013 | volume= 8 | issue= 1 | pages= 521 | pmid=27330607 | doi=10.2484/rcr.v8i1.521 | pmc=4900208 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27330607 }} </ref><ref name="pmid22605582">{{cite journal| author=Panneerselvam A, Subbiahnadar P| title=Is it dextrocardia or dextroversion? | journal=BMJ Case Rep | year= 2012 | volume= 2012 | issue= | pages= | pmid=22605582 | doi=10.1136/bcr.01.2012.5493 | pmc=3316784 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22605582 }} </ref><ref name="pmid26411880">{{cite journal| author=Ogunlade O, Ayoka AO, Akomolafe RO, Akinsomisoye OS, Irinoye AI, Ajao A | display-authors=etal| title=The role of electrocardiogram in the diagnosis of dextrocardia with mirror image atrial arrangement and ventricular position in a young adult Nigerian in Ile-Ife: a case report. | journal=J Med Case Rep | year= 2015 | volume= 9 | issue= | pages= 222 | pmid=26411880 | doi=10.1186/s13256-015-0695-4 | pmc=4584464 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26411880 }} </ref><ref name="MaldjianSaric2007">{{cite journal|last1=Maldjian|first1=Pierre D.|last2=Saric|first2=Muhamed|title=Approach to Dextrocardia in Adults:Review|journal=American Journal of Roentgenology|volume=188|issue=6_supplement|year=2007|pages=S39–S49|issn=0361-803X|doi=10.2214/AJR.06.1179}}</ref><br />
*Tricuspid atresia<br />
*Transposition of the great vessels<br />
*Pulmonary stenosis<br />
*Double-outlet double-inlet ventricle<br />
*Single ventricle<br />
*Sick sinus syndrome<br />
*Situs inversus<br />
*Situs solitus<br />
*Situs ambiguous<br />
*Kartagener syndrome<br />
*Double-outlet or double-inlet ventricles<br />
<br />
==References==<br />
{{Reflist|2}}<br />
<br />
{{WH}}<br />
{{WS}}<br />
[[Category: (name of the system)]]</div>
Ifeoma odukwe
https://www.wikidoc.org/index.php?title=Dextrocardia_pathophysiology&diff=1608812
Dextrocardia pathophysiology
2020-05-18T17:39:42Z
<p>Ifeoma odukwe: /* Embryology */</p>
<hr />
<div>__NOTOC__<br />
{{Dextrocardia}}<br />
<br />
{{CMG}}; {{AE}} <br />
==Overview==<br />
The exact pathogenesis of [disease name] is not fully understood.<br />
<br />
OR<br />
<br />
It is thought that [disease name] is the result of / is mediated by / is produced by / is caused by either [hypothesis 1], [hypothesis 2], or [hypothesis 3].<br />
<br />
OR<br />
<br />
[Pathogen name] is usually transmitted via the [transmission route] route to the human host.<br />
<br />
OR<br />
<br />
Following transmission/ingestion, the [pathogen] uses the [entry site] to invade the [cell name] cell.<br />
<br />
OR<br />
<br />
<br />
[Disease or malignancy name] arises from [cell name]s, which are [cell type] cells that are normally involved in [function of cells].<br />
<br />
OR<br />
<br />
The progression to [disease name] usually involves the [molecular pathway].<br />
<br />
OR<br />
<br />
The pathophysiology of [disease/malignancy] depends on the histological subtype.<br />
<br />
==Pathophysiology==<br />
===Embryology===<br />
*The fetal heart forms from an embryonic heart tube.<br />
<br />
===Pathogenesis===<br />
*Dextrocardia is a cardiac anomaly in which the major axis of the heart from base to apex points to the right side, in contrast to the normal orientation of the heart where the apex points to the left side. The term dextrocardia outlines the position of the cardiac axis only and not the chamber organisation and structural anatomy of the heart.<ref name="pmid26411880">{{cite journal| author=Ogunlade O, Ayoka AO, Akomolafe RO, Akinsomisoye OS, Irinoye AI, Ajao A | display-authors=etal| title=The role of electrocardiogram in the diagnosis of dextrocardia with mirror image atrial arrangement and ventricular position in a young adult Nigerian in Ile-Ife: a case report. | journal=J Med Case Rep | year= 2015 | volume= 9 | issue= | pages= 222 | pmid=26411880 | doi=10.1186/s13256-015-0695-4 | pmc=4584464 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26411880 }} </ref><ref name="pmid16287744">{{cite journal| author=Bernasconi A, Azancot A, Simpson JM, Jones A, Sharland GK| title=Fetal dextrocardia: diagnosis and outcome in two tertiary centres. | journal=Heart | year= 2005 | volume= 91 | issue= 12 | pages= 1590-4 | pmid=16287744 | doi=10.1136/hrt.2004.048330 | pmc=1769217 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16287744 }} </ref><br />
*The malposition is not as a result of any extracardiac abnormalities but intrinsic to the heart. It is as a result of embryological abnormalities that occur during the development of the heart.<ref name="MaldjianSaric2007">{{cite journal|last1=Maldjian|first1=Pierre D.|last2=Saric|first2=Muhamed|title=Approach to Dextrocardia in Adults:Review|journal=American Journal of Roentgenology|volume=188|issue=6_supplement|year=2007|pages=S39–S49|issn=0361-803X|doi=10.2214/AJR.06.1179}}</ref><br />
*Dextrocardia with a normal abdominal situs has a 90 to 95% chance of associated congenital cardiac anomalies including atrial septal defect, transposition of the great vessels, and ventricular septal defect. It has a lower incidence (0 to 10%) in the presence of situs inversus.<ref name="KumarSingh2014">{{cite journal|last1=Kumar|first1=Abnish|last2=Singh|first2=Manoj Kumar|last3=Yadav|first3=Neeraj|title=Dextrocardia and asplenia in situs inversus totalis in a baby: a case report|journal=Journal of Medical Case Reports|volume=8|issue=1|year=2014|issn=1752-1947|doi=10.1186/1752-1947-8-408}}</ref><br />
<br />
==Genetics==<br />
Genes involved in the pathogenesis of dextrocrdia include:<ref name="FahedGelb2013">{{cite journal|last1=Fahed|first1=Akl C.|last2=Gelb|first2=Bruce D.|last3=Seidman|first3=J. G.|last4=Seidman|first4=Christine E.|title=Genetics of Congenital Heart Disease|journal=Circulation Research|volume=112|issue=4|year=2013|pages=707–720|issn=0009-7330|doi=10.1161/CIRCRESAHA.112.300853}}</ref><br />
*ZIC3<br />
*ACVR2B<br />
*NODAL<br />
<br />
==Associated Conditions==<br />
Conditions associated with [disease name] include:<ref name="pmid27330607">{{cite journal| author=Khoury M, Harbieh B, Heriopian A| title=Isolated dextrocardia and congenital heart blocking. | journal=Radiol Case Rep | year= 2013 | volume= 8 | issue= 1 | pages= 521 | pmid=27330607 | doi=10.2484/rcr.v8i1.521 | pmc=4900208 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27330607 }} </ref><ref name="pmid22605582">{{cite journal| author=Panneerselvam A, Subbiahnadar P| title=Is it dextrocardia or dextroversion? | journal=BMJ Case Rep | year= 2012 | volume= 2012 | issue= | pages= | pmid=22605582 | doi=10.1136/bcr.01.2012.5493 | pmc=3316784 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22605582 }} </ref><ref name="pmid26411880">{{cite journal| author=Ogunlade O, Ayoka AO, Akomolafe RO, Akinsomisoye OS, Irinoye AI, Ajao A | display-authors=etal| title=The role of electrocardiogram in the diagnosis of dextrocardia with mirror image atrial arrangement and ventricular position in a young adult Nigerian in Ile-Ife: a case report. | journal=J Med Case Rep | year= 2015 | volume= 9 | issue= | pages= 222 | pmid=26411880 | doi=10.1186/s13256-015-0695-4 | pmc=4584464 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26411880 }} </ref><ref name="MaldjianSaric2007">{{cite journal|last1=Maldjian|first1=Pierre D.|last2=Saric|first2=Muhamed|title=Approach to Dextrocardia in Adults:Review|journal=American Journal of Roentgenology|volume=188|issue=6_supplement|year=2007|pages=S39–S49|issn=0361-803X|doi=10.2214/AJR.06.1179}}</ref><br />
*Tricuspid atresia<br />
*Transposition of the great vessels<br />
*Pulmonary stenosis<br />
*Double-outlet double-inlet ventricle<br />
*Single ventricle<br />
*Sick sinus syndrome<br />
*Situs inversus<br />
*Situs solitus<br />
*Situs ambiguous<br />
*Kartagener syndrome<br />
*Double-outlet or double-inlet ventricles<br />
<br />
==References==<br />
{{Reflist|2}}<br />
<br />
{{WH}}<br />
{{WS}}<br />
[[Category: (name of the system)]]</div>
Ifeoma odukwe
https://www.wikidoc.org/index.php?title=Dextrocardia_pathophysiology&diff=1608810
Dextrocardia pathophysiology
2020-05-18T17:23:50Z
<p>Ifeoma odukwe: /* Pathophysiology */</p>
<hr />
<div>__NOTOC__<br />
{{Dextrocardia}}<br />
<br />
{{CMG}}; {{AE}} <br />
==Overview==<br />
The exact pathogenesis of [disease name] is not fully understood.<br />
<br />
OR<br />
<br />
It is thought that [disease name] is the result of / is mediated by / is produced by / is caused by either [hypothesis 1], [hypothesis 2], or [hypothesis 3].<br />
<br />
OR<br />
<br />
[Pathogen name] is usually transmitted via the [transmission route] route to the human host.<br />
<br />
OR<br />
<br />
Following transmission/ingestion, the [pathogen] uses the [entry site] to invade the [cell name] cell.<br />
<br />
OR<br />
<br />
<br />
[Disease or malignancy name] arises from [cell name]s, which are [cell type] cells that are normally involved in [function of cells].<br />
<br />
OR<br />
<br />
The progression to [disease name] usually involves the [molecular pathway].<br />
<br />
OR<br />
<br />
The pathophysiology of [disease/malignancy] depends on the histological subtype.<br />
<br />
==Pathophysiology==<br />
===Embryology===<br />
The normal physiology of [name of process] can be understood as follows:<br />
<br />
===Pathogenesis===<br />
*Dextrocardia is a cardiac anomaly in which the major axis of the heart from base to apex points to the right side, in contrast to the normal orientation of the heart where the apex points to the left side. The term dextrocardia outlines the position of the cardiac axis only and not the chamber organisation and structural anatomy of the heart.<ref name="pmid26411880">{{cite journal| author=Ogunlade O, Ayoka AO, Akomolafe RO, Akinsomisoye OS, Irinoye AI, Ajao A | display-authors=etal| title=The role of electrocardiogram in the diagnosis of dextrocardia with mirror image atrial arrangement and ventricular position in a young adult Nigerian in Ile-Ife: a case report. | journal=J Med Case Rep | year= 2015 | volume= 9 | issue= | pages= 222 | pmid=26411880 | doi=10.1186/s13256-015-0695-4 | pmc=4584464 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26411880 }} </ref><ref name="pmid16287744">{{cite journal| author=Bernasconi A, Azancot A, Simpson JM, Jones A, Sharland GK| title=Fetal dextrocardia: diagnosis and outcome in two tertiary centres. | journal=Heart | year= 2005 | volume= 91 | issue= 12 | pages= 1590-4 | pmid=16287744 | doi=10.1136/hrt.2004.048330 | pmc=1769217 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16287744 }} </ref><br />
*The malposition is not as a result of any extracardiac abnormalities but intrinsic to the heart. It is as a result of embryological abnormalities that occur during the development of the heart.<ref name="MaldjianSaric2007">{{cite journal|last1=Maldjian|first1=Pierre D.|last2=Saric|first2=Muhamed|title=Approach to Dextrocardia in Adults:Review|journal=American Journal of Roentgenology|volume=188|issue=6_supplement|year=2007|pages=S39–S49|issn=0361-803X|doi=10.2214/AJR.06.1179}}</ref><br />
*Dextrocardia with a normal abdominal situs has a 90 to 95% chance of associated congenital cardiac anomalies including atrial septal defect, transposition of the great vessels, and ventricular septal defect. It has a lower incidence (0 to 10%) in the presence of situs inversus.<ref name="KumarSingh2014">{{cite journal|last1=Kumar|first1=Abnish|last2=Singh|first2=Manoj Kumar|last3=Yadav|first3=Neeraj|title=Dextrocardia and asplenia in situs inversus totalis in a baby: a case report|journal=Journal of Medical Case Reports|volume=8|issue=1|year=2014|issn=1752-1947|doi=10.1186/1752-1947-8-408}}</ref><br />
<br />
==Genetics==<br />
Genes involved in the pathogenesis of dextrocrdia include:<ref name="FahedGelb2013">{{cite journal|last1=Fahed|first1=Akl C.|last2=Gelb|first2=Bruce D.|last3=Seidman|first3=J. G.|last4=Seidman|first4=Christine E.|title=Genetics of Congenital Heart Disease|journal=Circulation Research|volume=112|issue=4|year=2013|pages=707–720|issn=0009-7330|doi=10.1161/CIRCRESAHA.112.300853}}</ref><br />
*ZIC3<br />
*ACVR2B<br />
*NODAL<br />
<br />
==Associated Conditions==<br />
Conditions associated with [disease name] include:<ref name="pmid27330607">{{cite journal| author=Khoury M, Harbieh B, Heriopian A| title=Isolated dextrocardia and congenital heart blocking. | journal=Radiol Case Rep | year= 2013 | volume= 8 | issue= 1 | pages= 521 | pmid=27330607 | doi=10.2484/rcr.v8i1.521 | pmc=4900208 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27330607 }} </ref><ref name="pmid22605582">{{cite journal| author=Panneerselvam A, Subbiahnadar P| title=Is it dextrocardia or dextroversion? | journal=BMJ Case Rep | year= 2012 | volume= 2012 | issue= | pages= | pmid=22605582 | doi=10.1136/bcr.01.2012.5493 | pmc=3316784 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22605582 }} </ref><ref name="pmid26411880">{{cite journal| author=Ogunlade O, Ayoka AO, Akomolafe RO, Akinsomisoye OS, Irinoye AI, Ajao A | display-authors=etal| title=The role of electrocardiogram in the diagnosis of dextrocardia with mirror image atrial arrangement and ventricular position in a young adult Nigerian in Ile-Ife: a case report. | journal=J Med Case Rep | year= 2015 | volume= 9 | issue= | pages= 222 | pmid=26411880 | doi=10.1186/s13256-015-0695-4 | pmc=4584464 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26411880 }} </ref><ref name="MaldjianSaric2007">{{cite journal|last1=Maldjian|first1=Pierre D.|last2=Saric|first2=Muhamed|title=Approach to Dextrocardia in Adults:Review|journal=American Journal of Roentgenology|volume=188|issue=6_supplement|year=2007|pages=S39–S49|issn=0361-803X|doi=10.2214/AJR.06.1179}}</ref><br />
*Tricuspid atresia<br />
*Transposition of the great vessels<br />
*Pulmonary stenosis<br />
*Double-outlet double-inlet ventricle<br />
*Single ventricle<br />
*Sick sinus syndrome<br />
*Situs inversus<br />
*Situs solitus<br />
*Situs ambiguous<br />
*Kartagener syndrome<br />
*Double-outlet or double-inlet ventricles<br />
<br />
==References==<br />
{{Reflist|2}}<br />
<br />
{{WH}}<br />
{{WS}}<br />
[[Category: (name of the system)]]</div>
Ifeoma odukwe
https://www.wikidoc.org/index.php?title=Dextrocardia_pathophysiology&diff=1608809
Dextrocardia pathophysiology
2020-05-18T17:14:13Z
<p>Ifeoma odukwe: /* Pathophysiology */</p>
<hr />
<div>__NOTOC__<br />
{{Dextrocardia}}<br />
<br />
{{CMG}}; {{AE}} <br />
==Overview==<br />
The exact pathogenesis of [disease name] is not fully understood.<br />
<br />
OR<br />
<br />
It is thought that [disease name] is the result of / is mediated by / is produced by / is caused by either [hypothesis 1], [hypothesis 2], or [hypothesis 3].<br />
<br />
OR<br />
<br />
[Pathogen name] is usually transmitted via the [transmission route] route to the human host.<br />
<br />
OR<br />
<br />
Following transmission/ingestion, the [pathogen] uses the [entry site] to invade the [cell name] cell.<br />
<br />
OR<br />
<br />
<br />
[Disease or malignancy name] arises from [cell name]s, which are [cell type] cells that are normally involved in [function of cells].<br />
<br />
OR<br />
<br />
The progression to [disease name] usually involves the [molecular pathway].<br />
<br />
OR<br />
<br />
The pathophysiology of [disease/malignancy] depends on the histological subtype.<br />
<br />
==Pathophysiology==<br />
===Physiology===<br />
The normal physiology of [name of process] can be understood as follows:<br />
<br />
===Pathogenesis===<br />
*Dextrocardia is a cardiac anomaly in which the major axis of the heart from base to apex points to the right side, in contrast to the normal orientation of the heart where the apex points to the left side. The term dextrocardia outlines the position of the cardiac axis only and not the chamber organisation and structural anatomy of the heart.<ref name="pmid26411880">{{cite journal| author=Ogunlade O, Ayoka AO, Akomolafe RO, Akinsomisoye OS, Irinoye AI, Ajao A | display-authors=etal| title=The role of electrocardiogram in the diagnosis of dextrocardia with mirror image atrial arrangement and ventricular position in a young adult Nigerian in Ile-Ife: a case report. | journal=J Med Case Rep | year= 2015 | volume= 9 | issue= | pages= 222 | pmid=26411880 | doi=10.1186/s13256-015-0695-4 | pmc=4584464 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26411880 }} </ref><ref name="pmid16287744">{{cite journal| author=Bernasconi A, Azancot A, Simpson JM, Jones A, Sharland GK| title=Fetal dextrocardia: diagnosis and outcome in two tertiary centres. | journal=Heart | year= 2005 | volume= 91 | issue= 12 | pages= 1590-4 | pmid=16287744 | doi=10.1136/hrt.2004.048330 | pmc=1769217 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16287744 }} </ref><br />
*The malposition is not as a result of any extracardiac abnormalities but intrinsic to the heart. It is as a result of embryological abnormalities that occur during the development of the heart.<ref name="MaldjianSaric2007">{{cite journal|last1=Maldjian|first1=Pierre D.|last2=Saric|first2=Muhamed|title=Approach to Dextrocardia in Adults:Review|journal=American Journal of Roentgenology|volume=188|issue=6_supplement|year=2007|pages=S39–S49|issn=0361-803X|doi=10.2214/AJR.06.1179}}</ref><br />
*Dextrocardia with a normal abdominal situs has a 90 to 95% chance of associated congenital cardiac anomalies including atrial septal defect, transposition of the great vessels, and ventricular septal defect. It has a lower incidence (0 to 10%) in the presence of situs inversus.<ref name="KumarSingh2014">{{cite journal|last1=Kumar|first1=Abnish|last2=Singh|first2=Manoj Kumar|last3=Yadav|first3=Neeraj|title=Dextrocardia and asplenia in situs inversus totalis in a baby: a case report|journal=Journal of Medical Case Reports|volume=8|issue=1|year=2014|issn=1752-1947|doi=10.1186/1752-1947-8-408}}</ref><br />
<br />
==Genetics==<br />
Genes involved in the pathogenesis of dextrocrdia include:<ref name="FahedGelb2013">{{cite journal|last1=Fahed|first1=Akl C.|last2=Gelb|first2=Bruce D.|last3=Seidman|first3=J. G.|last4=Seidman|first4=Christine E.|title=Genetics of Congenital Heart Disease|journal=Circulation Research|volume=112|issue=4|year=2013|pages=707–720|issn=0009-7330|doi=10.1161/CIRCRESAHA.112.300853}}</ref><br />
*ZIC3<br />
*ACVR2B<br />
*NODAL<br />
<br />
==Associated Conditions==<br />
Conditions associated with [disease name] include:<ref name="pmid27330607">{{cite journal| author=Khoury M, Harbieh B, Heriopian A| title=Isolated dextrocardia and congenital heart blocking. | journal=Radiol Case Rep | year= 2013 | volume= 8 | issue= 1 | pages= 521 | pmid=27330607 | doi=10.2484/rcr.v8i1.521 | pmc=4900208 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27330607 }} </ref><ref name="pmid22605582">{{cite journal| author=Panneerselvam A, Subbiahnadar P| title=Is it dextrocardia or dextroversion? | journal=BMJ Case Rep | year= 2012 | volume= 2012 | issue= | pages= | pmid=22605582 | doi=10.1136/bcr.01.2012.5493 | pmc=3316784 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22605582 }} </ref><ref name="pmid26411880">{{cite journal| author=Ogunlade O, Ayoka AO, Akomolafe RO, Akinsomisoye OS, Irinoye AI, Ajao A | display-authors=etal| title=The role of electrocardiogram in the diagnosis of dextrocardia with mirror image atrial arrangement and ventricular position in a young adult Nigerian in Ile-Ife: a case report. | journal=J Med Case Rep | year= 2015 | volume= 9 | issue= | pages= 222 | pmid=26411880 | doi=10.1186/s13256-015-0695-4 | pmc=4584464 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26411880 }} </ref><ref name="MaldjianSaric2007">{{cite journal|last1=Maldjian|first1=Pierre D.|last2=Saric|first2=Muhamed|title=Approach to Dextrocardia in Adults:Review|journal=American Journal of Roentgenology|volume=188|issue=6_supplement|year=2007|pages=S39–S49|issn=0361-803X|doi=10.2214/AJR.06.1179}}</ref><br />
*Tricuspid atresia<br />
*Transposition of the great vessels<br />
*Pulmonary stenosis<br />
*Double-outlet double-inlet ventricle<br />
*Single ventricle<br />
*Sick sinus syndrome<br />
*Situs inversus<br />
*Situs solitus<br />
*Situs ambiguous<br />
*Kartagener syndrome<br />
*Double-outlet or double-inlet ventricles<br />
<br />
==References==<br />
{{Reflist|2}}<br />
<br />
{{WH}}<br />
{{WS}}<br />
[[Category: (name of the system)]]</div>
Ifeoma odukwe
https://www.wikidoc.org/index.php?title=Sandbox:_ifrah&diff=1608437
Sandbox: ifrah
2020-05-16T16:28:23Z
<p>Ifeoma odukwe: </p>
<hr />
<div>[[Diabetes]]</div>
Ifeoma odukwe
https://www.wikidoc.org/index.php?title=Sandbox:_ifrah&diff=1608436
Sandbox: ifrah
2020-05-16T16:26:46Z
<p>Ifeoma odukwe: </p>
<hr />
<div>Ifrah Fatima</div>
Ifeoma odukwe
https://www.wikidoc.org/index.php?title=Dextrocardia_medical_therapy&diff=1608435
Dextrocardia medical therapy
2020-05-16T16:22:11Z
<p>Ifeoma odukwe: Created page with "__NOTOC__ {{Dextrocardia}} {{CMG}}; {{AE}} ==Overview== There is no treatment for [disease name]; the mainstay of therapy is supportive care. OR Supportive therapy for [dis..."</p>
<hr />
<div>__NOTOC__<br />
{{Dextrocardia}}<br />
{{CMG}}; {{AE}}<br />
<br />
==Overview==<br />
There is no treatment for [disease name]; the mainstay of therapy is supportive care.<br />
<br />
OR<br />
<br />
Supportive therapy for [disease name] includes [therapy 1], [therapy 2], and [therapy 3].<br />
<br />
OR<br />
<br />
The majority of cases of [disease name] are self-limited and require only supportive care.<br />
<br />
OR<br />
<br />
[Disease name] is a medical emergency and requires prompt treatment.<br />
<br />
OR<br />
<br />
The mainstay of treatment for [disease name] is [therapy].<br />
<br />
OR<br />
<br />
The optimal therapy for [malignancy name] depends on the stage at diagnosis.<br />
<br />
OR<br />
<br />
[Therapy] is recommended among all patients who develop [disease name].<br />
<br />
OR<br />
<br />
Pharmacologic medical therapy is recommended among patients with [disease subclass 1], [disease subclass 2], and [disease subclass 3].<br />
<br />
OR<br />
<br />
Pharmacologic medical therapies for [disease name] include (either) [therapy 1], [therapy 2], and/or [therapy 3].<br />
<br />
OR<br />
<br />
Empiric therapy for [disease name] depends on [disease factor 1] and [disease factor 2].<br />
<br />
OR<br />
<br />
Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2].<br />
<br />
==Medical Therapy==<br />
*Pharmacologic medical therapy is recommended among patients with [disease subclass 1], [disease subclass 2], and [disease subclass 3]. <br />
*Pharmacologic medical therapies for [disease name] include (either) [therapy 1], [therapy 2], and/or [therapy 3].<br />
*Empiric therapy for [disease name] depends on [disease factor 1] and [disease factor 2].<br />
*Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2].<br />
===Disease Name===<br />
<br />
* '''1 Stage 1 - Name of stage'''<br />
** 1.1 '''Specific Organ system involved 1'''<br />
*** 1.1.1 '''Adult'''<br />
**** Preferred regimen (1): [[drug name]] 100 mg PO q12h for 10-21 days '''(Contraindications/specific instructions)''' <br />
**** Preferred regimen (2): [[drug name]] 500 mg PO q8h for 14-21 days<br />
**** Preferred regimen (3): [[drug name]] 500 mg q12h for 14-21 days<br />
**** Alternative regimen (1): [[drug name]] 500 mg PO q6h for 7–10 days <br />
**** Alternative regimen (2): [[drug name]] 500 mg PO q12h for 14–21 days<br />
**** Alternative regimen (3): [[drug name]] 500 mg PO q6h for 14–21 days<br />
*** 1.1.2 '''Pediatric'''<br />
**** 1.1.2.1 (Specific population e.g. '''children < 8 years of age''')<br />
***** Preferred regimen (1): [[drug name]] 50 mg/kg PO per day q8h (maximum, 500 mg per dose) <br />
***** Preferred regimen (2): [[drug name]] 30 mg/kg PO per day in 2 divided doses (maximum, 500 mg per dose)<br />
***** Alternative regimen (1): [[drug name]]10 mg/kg PO q6h (maximum, 500 mg per day)<br />
***** Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h (maximum, 500 mg per dose)<br />
***** Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h (maximum, 500 mg per dose)<br />
****1.1.2.2 (Specific population e.g. '<nowiki/>'''''children < 8 years of age'''''')<br />
***** Preferred regimen (1): [[drug name]] 4 mg/kg/day PO q12h(maximum, 100 mg per dose)<br />
***** Alternative regimen (1): [[drug name]] 10 mg/kg PO q6h (maximum, 500 mg per day)<br />
***** Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h (maximum, 500 mg per dose) <br />
***** Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h (maximum, 500 mg per dose)<br />
** 1.2 '''Specific Organ system involved 2'''<br />
*** 1.2.1 '''Adult'''<br />
**** Preferred regimen (1): [[drug name]] 500 mg PO q8h <br />
*** 1.2.2 '''Pediatric'''<br />
**** Preferred regimen (1): [[drug name]] 50 mg/kg/day PO q8h (maximum, 500 mg per dose)<br />
<br />
* 2 '''Stage 2 - Name of stage'''<br />
** 2.1 '''Specific Organ system involved 1 '''<br />
**: '''Note (1):''' <br />
**: '''Note (2)''': <br />
**: '''Note (3):''' <br />
*** 2.1.1 '''Adult'''<br />
**** Parenteral regimen<br />
***** Preferred regimen (1): [[drug name]] 2 g IV q24h for 14 (14–21) days<br />
***** Alternative regimen (1): [[drug name]] 2 g IV q8h for 14 (14–21) days<br />
***** Alternative regimen (2): [[drug name]] 18–24 MU/day IV q4h for 14 (14–21) days<br />
**** Oral regimen<br />
***** Preferred regimen (1): [[drug name]] 500 mg PO q8h for 14 (14–21) days <br />
***** Preferred regimen (2): [[drug name]] 100 mg PO q12h for 14 (14–21) days <br />
***** Preferred regimen (3): [[drug name]] 500 mg PO q12h for 14 (14–21) days<br />
***** Alternative regimen (1): [[drug name]] 500 mg PO q6h for 7–10 days <br />
***** Alternative regimen (2): [[drug name]] 500 mg PO q12h for 14–21 days <br />
***** Alternative regimen (3):[[drug name]] 500 mg PO q6h for 14–21 days<br />
*** 2.1.2 '''Pediatric'''<br />
**** Parenteral regimen<br />
***** Preferred regimen (1): [[drug name]] 50–75 mg/kg IV q24h for 14 (14–21) days (maximum, 2 g)<br />
***** Alternative regimen (1): [[drug name]] 150–200 mg/kg/day IV q6–8h for 14 (14–21) days (maximum, 6 g per day)<br />
***** Alternative regimen (2): [[drug name]] 200,000–400,000 U/kg/day IV q4h for 14 (14–21) days (maximum, 18–24 million U per day) '<nowiki/>'''''(Contraindications/specific instructions)''''''<br />
**** Oral regimen<br />
***** Preferred regimen (1): [[drug name]] 50 mg/kg/day PO q8h for 14 (14–21) days (maximum, 500 mg per dose)<br />
***** Preferred regimen (2): [[drug name]] '''(for children aged ≥ 8 years)''' 4 mg/kg/day PO q12h for 14 (14–21) days (maximum, 100 mg per dose)<br />
***** Preferred regimen (3): [[drug name]] 30 mg/kg/day PO q12h for 14 (14–21) days (maximum, 500 mg per dose)<br />
***** Alternative regimen (1): [[drug name]] 10 mg/kg PO q6h 7–10 days (maximum, 500 mg per day)<br />
***** Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h for 14–21 days (maximum, 500 mg per dose)<br />
***** Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h for 14–21 days (maximum,500 mg per dose)<br />
** 2.2 '<nowiki/>'''''Other Organ system involved 2''''''<br />
**: '''Note (1):''' <br />
**: '''Note (2)''': <br />
**: '''Note (3):''' <br />
*** 2.2.1 '''Adult'''<br />
**** Parenteral regimen<br />
***** Preferred regimen (1): [[drug name]] 2 g IV q24h for 14 (14–21) days<br />
***** Alternative regimen (1): [[drug name]] 2 g IV q8h for 14 (14–21) days<br />
***** Alternative regimen (2): [[drug name]] 18–24 MU/day IV q4h for 14 (14–21) days <br />
**** Oral regimen<br />
***** Preferred regimen (1): [[drug name]] 500 mg PO q8h for 14 (14–21) days <br />
***** Preferred regimen (2): [[drug name]] 100 mg PO q12h for 14 (14–21) days <br />
***** Preferred regimen (3): [[drug name]] 500 mg PO q12h for 14 (14–21) days<br />
***** Alternative regimen (1): [[drug name]] 500 mg PO q6h for 7–10 days <br />
***** Alternative regimen (2): [[drug name]] 500 mg PO q12h for 14–21 days <br />
***** Alternative regimen (3):[[drug name]] 500 mg PO q6h for 14–21 days<br />
*** 2.2.2 '''Pediatric'''<br />
**** Parenteral regimen<br />
***** Preferred regimen (1): [[drug name]] 50–75 mg/kg IV q24h for 14 (14–21) days (maximum, 2 g)<br />
***** Alternative regimen (1): [[drug name]] 150–200 mg/kg/day IV q6–8h for 14 (14–21) days (maximum, 6 g per day)<br />
***** Alternative regimen (2): [[drug name]] 200,000–400,000 U/kg/day IV q4h for 14 (14–21) days (maximum, 18–24 million U per day) <br />
**** Oral regimen<br />
***** Preferred regimen (1): [[drug name]] 50 mg/kg/day PO q8h for 14 (14–21) days (maximum, 500 mg per dose)<br />
***** Preferred regimen (2): [[drug name]] 4 mg/kg/day PO q12h for 14 (14–21) days (maximum, 100 mg per dose)<br />
***** Preferred regimen (3): [[drug name]] 30 mg/kg/day PO q12h for 14 (14–21) days (maximum, 500 mg per dose)<br />
***** Alternative regimen (1): [[drug name]] 10 mg/kg PO q6h 7–10 days (maximum, 500 mg per day)<br />
***** Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h for 14–21 days (maximum, 500 mg per dose)<br />
***** Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h for 14–21 days (maximum,500 mg per dose)<br />
<br />
==References==<br />
{{Reflist|2}}<br />
<br />
{{WH}}<br />
{{WS}}<br />
[[Category: (name of the system)]]</div>
Ifeoma odukwe
https://www.wikidoc.org/index.php?title=Sandbox:_Ifeoma&diff=1608432
Sandbox: Ifeoma
2020-05-16T16:05:15Z
<p>Ifeoma odukwe: </p>
<hr />
<div>Wikidoc practice session<br />
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{{cquote|I can't wait for covid to be over!}}<br />
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{{SK}}<br />
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==Classification of dextrocardia==<br />
{| style="border: 0px; font-size: 90%; margin: 3px; width: 1000px"<br />
|valign=top|<br />
|+<br />
! style="background: #4479BA; width: 250px; color: #FFFFFF;"|'''Dextrocardia Types'''<br />
<br />
! style="background: #4479BA; width: 600px; color: #FFFFFF;"|'''Description'''<br />
<br />
|-<br />
<br />
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align=center | '''Dextrocardia with situs solitus '''|| style="padding: 5px 5px; background: #F5F5F5;" |<br />
:* Dextrocardia with normally related great arteries and D-transposition (complete transposition) or L-transposition (congenitally corrected transposition) of the great arteries. Some examples include dextrocardia with D-loop ventricles and normally related great arteries, with L-loop ventricles and L-TGA (congenitally corrected TGA).<br />
:* Embryologic failure of the final leftward shift of the ventricles during development results in dextrocardia with situs solitus, D-loop ventricles, and normally related great arteries.<br />
<br />
|-<br />
<br />
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align=center | '''Dextrocardia with situs inversus '''|| style="padding: 5px 5px; background: #F5F5F5;"|<br />
:* May present with dextrocardia with inversely related great arteries and D-transposition (congenitally corrected transposition) or L-transposition (“uncorrected” transposition) of the great arteries. An example is dextrocardia with D-loop ventricles and D-TGA (congenitally corrected TGA).<br />
<br />
|-<br />
<br />
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align=center | '''Dextrocardia with situs ambiguous (either polyspenia or asplenia)''' || style="padding: 5px 5px; background: #F5F5F5;"|<br />
:* Dextrocardia with any of the above relationships between the ventricles and great vessels.<br />
<br />
|-<br />
<br />
<br />
{|<br />
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"<br />
! rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;|Diseases<br />
| colspan="6" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;|'''Clinical manifestations'''<br />
! colspan="3" rowspan="2" |Para-clinical findings<br />
| colspan="1" rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;|'''Gold standard'''<br />
! rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;|Additional findings<br />
|-<br />
| colspan="3" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;|'''Symptoms'''<br />
! colspan="3" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;|Physical examination<br />
|-<br />
! colspan="3" style="background: #4479BA; color: #FFFFFF; text-align: center;|Imaging<br />
|- <br />
! style="background: #4479BA; color: #FFFFFF; text-align: center;|Exertional dyspnea<br />
! colspan="1" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;|Failure to thrive<br />
! style="background: #4479BA; color: #FFFFFF; text-align: center;|Recurrent respiratory infections<br />
! style="background: #4479BA; color: #FFFFFF; text-align: center;|Murmur on auscultation<br />
! colspan="1" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;|Peripheral edema<br />
! style="background: #4479BA; color: #FFFFFF; text-align: center;|Clubbing<br />
! style="background: #4479BA; color: #FFFFFF; text-align: center;|Echocardiography<br />
! style="background: #4479BA; color: #FFFFFF; text-align: center;|Chest x-ray<br />
! style="background: #4479BA; color: #FFFFFF; text-align: center;|Cardiac CT<br />
|-<br />
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Patent foramen ovale]]<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Appearance of at least 3 micro-bubbles in the left atrium within three cardiac cycles after complete opacification of the right atrium<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | Non specific<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | <br />
* A contrast agent jet from the left atrium to the right atrium toward the inferior vena cava with channel-like appearance of the interatrial septum<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Echocardiogram<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* It is associated with paradoxical embolism, migraine headache, and decompression sickness in divers<br />
|-<br />
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Atrial septal defect]]<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/−<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/−<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/− <br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Systolic flow murmur in the upper left sternal border<br />
* Wide, fixed splitting of S2<br />
* Diastolic flow rumble across the tricuspid valve<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/−<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/−<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Hypermobile interatrial septum<br />
* Abrupt septal irregularity<br />
* Right atrial and ventricular volume overload<br />
* Pulmonary artery dilatation<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Cardiomegaly <br />
* Pulmonary artery enlargement/increased pulmonary vascularity<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Enlargement of the right atrium and ventricle<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Echocardiogram<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Atrial septal defect is classified into 5 types including ostium primum defect, ostium secundum defect, superior sinus venosus defect, inferior sinus venosus defect, and coronary sinus defect<br />
|-<br />
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Ventricular septal defect]]<br />
| style="background: #F5F5F5; padding: 5px;" |-/+<br />
| style="background: #F5F5F5; padding: 5px;" |-/+<br />
| style="background: #F5F5F5; padding: 5px;" |After Eisenmenger syndrome<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Holosystolic murmur<br />
* May mimic aortic stenosis(mid/end dyastolic murmur due to increased pulmonary circulation)<br />
| style="background: #F5F5F5; padding: 5px;" |-/+<br />
| style="background: #F5F5F5; padding: 5px;" |-/+<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Defect localization<br />
*septal dropout in the area adjacent to the tricuspid septal leaflet and below the right border of the aortic annulus<br />
* Direction of jet<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* [[Cardiomegaly]] in large VSD<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Direct visualisation of murmur<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Echocardiogram<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"<br />
!Diseases<br />
!Exertional dyspnea<br />
! colspan="1" rowspan="1" |Failure to thrive<br />
!Recurrent respiratory infections<br />
!Murmur on auscultation<br />
! colspan="1" rowspan="1" |Peripheral edema<br />
!Clubbing<br />
!Echocardiography<br />
!Chest x-ray<br />
!Cardiac CT<br />
|'''Gold standard'''<br />
!Additional findings<br />
|-<br />
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Patent ductus arteriosus]]<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Not at beginning<br />
* May be produced during the course of disease <br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Depends on the size<br />
| style="background: #F5F5F5; padding: 5px;" | -<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Continuous machine-like murmur<br />
| style="background: #F5F5F5; padding: 5px;" |-<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* May be present by progressing<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Golden standard <br />
* In color-Doppler visualization of flow through the patent duct which has a high velocity<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Non-specific<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Used for determining Krichenko classification<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Echocardiogram<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Krichenko criteria for classification is a very important factor for treatment<br />
|-<br />
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Aortic coarctation|Coarctation of the aorta]]<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/−<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/−<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Systolic murmur over the upper sternal border with radiation to the back<br />
*Murmur of mitral regurgitation (holosystolic murmur best heard at the apex)<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Narrowing of the aortic arch at the level of the isthmus<br />
* Left ventricular hypertrophy<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Notching of the posterior fourth to eighth ribs due to dilated intercostal arteries<br />
* Indentation of the aorta at the site of coarctation with pre- and post-stenotic dilation of the aorta (classic "3 sign")<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Dilation of the intercostal arteries<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Echocardiogram<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
*Patients present with arm-leg blood pressure gradient of >20mmHg<br />
|-<br />
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Aortic stenosis]]<br />
| style="background: #F5F5F5; padding: 5px;" |+<br />
| style="background: #F5F5F5; padding: 5px;" |+<br />
| style="background: #F5F5F5; padding: 5px;" |+<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Crescendo-decrescendo mid-systolic (or ejection systolic) murmur<br />
| style="background: #F5F5F5; padding: 5px;" |+/-<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Depending on severity<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Used for finding the location of stenosis<br />
* Finding severity<br />
* Evaluating the flow jet with color-Doppler ultrasound technique<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Non-specific at the beginning<br />
* At progressed stage calcification of the valve and cardiomegally<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
*[[Aortic calcification|Calcification score]]<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* MRI<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* MRI provides a more detailed structural and dynamic assessment of the aortic valve and left ventricle, in particular<br />
|-<br />
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Pulmonary valve stenosis|Pulmonary stenosis]]<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Depending on severity<br />
| style="background: #F5F5F5; padding: 5px;" | -<br />
| style="background: #F5F5F5; padding: 5px;" | -/+<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Continuous systolic murmur<br />
| style="background: #F5F5F5; padding: 5px;" |-<br />
| style="background: #F5F5F5; padding: 5px;" | -/+<br />
| style="background: #F5F5F5; padding: 5px;" | <br />
* Right atrial hypertrophy<br />
| style="background: #F5F5F5; padding: 5px;" | <br />
* Non-specific<br />
| style="background: #F5F5F5; padding: 5px;" | <br />
* Direct visualization of stenosis<br />
| style="background: #F5F5F5; padding: 5px;" | <br />
* Echocardiogram<br />
| style="background: #F5F5F5; padding: 5px;" | <br />
|}<br />
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<br />
{| class="wikitable"<br />
|+<br />
!Diseases<br />
!Pathophysiology<br />
!Shunt<br />
!Symptoms<br />
!Diagnosis<br />
!Echocardiography findings<br />
!Physical examination<br />
!Treatment<br />
!Complications<br />
|-<br />
|Patent foramen ovale<br />
|<br />
* Failure of fusion of the septum primum and septum secundum leading to a flap valve opening.<br />
|<br />
* Right-to-left shunt<br />
<br />
* More prominent with increased right atrial pressure.<br />
|<br />
* Majority of patients are asymptomatic<br />
|<br />
* TEE (Gold standard)<br />
<br />
* TTE<br />
<br />
* TCD<br />
|<br />
* Appearance of at least 3 micro-bubbles in the left atrium within three cardiac cycles after the complete opacification of the right atrium<br />
|<br />
|<br />
* Percutaneous closure<br />
* Anticoagulants<br />
* Antiplatelets<br />
|<br />
* Paradoxical embolism<br />
<br />
* Migraine with aura<br />
*Decompression sickness in divers<br />
*Platypnea-orthodeoxia syndrome<br /><br />
|-<br />
|Atrial septal defect<br />
|<br />
* '''Ostium secundum defect''': Failure of the septum secundum to occlude the ostium secundum.<br />
<br />
* '''Ostium primum defect''': Failure of the ostium primum to fuse with the endocardial cushions.<br />
<br />
* '''Superior sinus venosus defect''': The orifice of the superior vena cava overrides the atrial septum above the fossa ovalis.<br />
<br />
* '''Inferior sinus venosus defect''': The orifice of the inferior vena cava overrides the left and right atrium.<br />
*'''Coronary sinus defect''': Absence of a portion of the common wall that separates the coronary sinus and the left atrium.<br />
|<br />
* Continuous left-to-right shunt<br />
|<br />
* Failure to thrive, tachypnea, recurrent respiratory infections, heart failure<br />
<br />
* Commonly asymptomatic during childhood and adolescence<br />
*Adults with large shunts may become symptomatic in the fourth decade presenting with fatigue, exercise intolerance, palpitations, syncope, and shortness of breath.<br />
<br />
*<br />
|<br />
* TTE (Gold standard)<br />
*Cardiac CT<br />
*Cardiac MRI<br />
|<br />
* Hypermobile interatrial septum<br />
* Abrupt septal irregularity<br />
* Right atrial and ventricular volume overload<br />
* Pulmonary artery dilation<br />
*'''Coronary sinus defect''': Enlarged ostium of the coronary sinus and unroofing of the terminal portion of the coronary sinus<br />
|<br />
* Systolic flow murmur in the pulmonary valve region<br />
*Wide, fixed splitting of S2<br />
*Diastolic flow rumble across the tricuspid valve<br />
*Right ventricular heave <br />
|<br />
* Spontaneous closure<br />
*Percutaneous transcatheter closure<br />
*Surgical closure<br />
|<br />
* Right sided heart failure<br />
* Peripheral edema<br />
* Eisenmenger syndrome (cyanosis)<br />
* Paradoxical emboli<br />
* Pulmonary hypertension<br />
|-<br />
|Pulmonary ateriovenous fistula<br />
|<br />
* Abnormal blood vessel(s) connecting the pulmonary arteries and veins directly without interposition of pulmonary capillaries<br />
|<br />
* Right-to-left shunt between the pulmonary artery and pulmonary vein<br />
|<br />
* Symptoms may occur only after the second decade<br />
*Cyanosis<br />
*Hemoptysis<br />
|<br />
* Chest CT<br />
*Pulmonary arteriogram<br />
|<br />
* Appearance of contrast bubbles in the left atrium three to five cardiac cycles after appearance in the right atrium<br />
|<br />
* Clubbing<br />
*Systolic/continuous murmur<br />
|<br />
* Embolization<br />
* Surgical resection<br />
|<br />
* Cerebral ischemia/abscess<br />
*Hemothorax<br />
|}<br />
<br />
==Differential table for aortic stenosis==<br />
<br />
{| class="wikitable"<br />
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;|Diseases<br />
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;|History<br />
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;|Symptoms<br />
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;|Physical Examination<br />
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;|Murmur<br />
! colspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;|Diagnosis<br />
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;|Other Findings<br />
|- style="background: #DCDCDC; padding: 5px; text-align: center;"<br />
!style="background: #4479BA; color: #FFFFFF; text-align: center;|ECG<br />
!style="background: #4479BA; color: #FFFFFF; text-align: center;|CXR<br />
!style="background: #4479BA; color: #FFFFFF; text-align: center;|Echocardiogram<br />
!style="background: #4479BA; color: #FFFFFF; text-align: center;|Cardiac Catheterization<br />
|-<br />
|style="background: #DCDCDC; padding: 5px; text-align: center;" |Aortic stenosis<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Age (aortic valve calcification)<br />
*Syncope<br />
*Orthopnea<br />
*Paroxysmal nocturnal dyspnea<br />
*Acute rheumatic fever<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Chest pain<br />
*Dyspnea on exertion<br />
*Palpitations<br />
*Symptoms of heart failure<br />
| style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Pulsus parvus et tardus<br />
*Pulmonary rales<br />
*Peripheral edema (In CHF patients)<br />
*Jugular venous distension<br />
*Enlarged and laterally displaced point of maximal impulse<br />
<br />
*<br />
| style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Crescendo-decrescendo systolic murmur<br />
*Best heard at the right upper sternal border<br />
*Radiation to the carotid arteries<br />
*Increases with squatting<br />
*Decreases with valsalva maneuver<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Left ventricular hypertrophy''':<br />
<br />
* Wide QRS complex (especially in leads V1-V6)<br />
*ST depression in leads V5-V6<br />
*Left axis deviation<br />
* <br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Enlarged left ventricle<br />
* Enlarged left atrium and pulmonary artery in severe cases<br />
*Calcification of the aortic valve<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Thickening and calcification of the aortic valve<br />
*Left ventricular hypertrophy<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Left heart catheterization:'''<br />
<br />
* Left ventricular and aortic pressures<br />
*The left ventricle generates higher pressures than what is transmitted to the aorta<br />
| style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Associated with von Willibrand disease<br />
|-<br />
| colspan="10" |<br />
|-<br />
|style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Mitral Stenosis]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Age ( Mitral annular calcification in older patients)<br />
<br />
* [[Rheumatic fever]]<br />
<br />
* [[Endocarditis]]<br />
<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* [[Dyspnea on exertion]]<br />
<br />
* [[Paroxysmal nocturnal dyspnea]]<br />
<br />
* [[Orthopnea]]<br />
<br />
* New onset [[atrial fibrillation]]<br />
<br />
| style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Mitral facies<br />
<br />
* Heart murmur<br />
<br />
* [[JVD|Jugular vein distension]]<br />
<br />
* Apical impulse displaced laterally or not palpable <br />
<br />
* Diastolic thrill at the apex <br />
<br />
* Signs of heart failure in severe cases<br />
| style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Diastolic murmur<br />
<br />
* Low pitched<br />
<br />
* Opening snap followed by decrescendo-crescendo rumbling murmur <br />
<br />
* Best heard with the bell of the stethoscope at apex at end-expiration in left lateral decubitus position <br />
<br />
* Intensity increases after a [[valsalva maneuver]], after exercise and after increased after load (eg., squatting, isometric hand grip) <br />
| style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* [[P mitrale]]<br />
* [[Atrial fibrillation]]: No P waves and irregularly irregular rhythm<br />
<br />
* [[Right axis deviation]]<br />
<br />
* Right ventricular hypertropy: Dominant R wave in V1 and V2<br />
| style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Straightening of the left border of the heart suggestive of enlargement of the [[left atrium]]<br />
<br />
* Double right heart border (Enlarged left atrium and normal right atrium) <br />
<br />
* Prominent left atrial appendage<br />
<br />
* Splaying of [[carina|subcarinal angle]] (>120 degrees)<br />
<br />
* Calcification of [[mitral valve]]<br />
<br />
* [[Kerley B lines]] <br />
<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Reduced valve leaflet mobility<br />
<br />
* Valve calcification <br />
<br />
* Doming of mitral valve<br />
<br />
* Valve thickening <br />
* Enlargement of left atrium <br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Right heart catheterization:'''<br />
* [[Pulmonary capillary wedge pressure]] (left atrial pressure) <br />
'''Left heart catheterization:'''<br />
* Pressures in left ventricle<br />
<br />
* Determines the gradient between the left and right atrium during ventricular diastole (marker of the severity of mitral stenosis)<br />
<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* [[Hemoptysis]] ([[heart failure]])<br />
<br />
* [[Ortner's syndrome]]<br />
|-<br />
| colspan="10" |<br />
|-<br />
|style="vertical-align: top;background: #DCDCDC; padding: 5px; text-align: center;" |[[Mitral Regurgitation]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* [[CAD]]<br />
<br />
* [[MI]]<br />
<br />
* [[Rheumatic fever]]<br />
<br />
* [[Endocarditis]]<br />
<br />
* [[Mitral valve prolapse]]<br />
<br />
* [[Cardiomyopathy]]<br />
<br />
* [[Radiation therapy]]<br />
<br />
* Trauma<br />
<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* [[Palpitations]]<br />
<br />
* Symptoms of heart failure in severe cases<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Palpation'''<br />
* Brisk carotid upstroke and hyperdymanic carotid impulse on palpation<br />
<br />
* Apical impulse is displaced to left<br />
<br />
* S3 and a palpable thrill<br />
'''Auscultation'''<br />
* Murmur<br />
<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* [[Holosystolic murmur]]<br />
<br />
* High pitched, blowing<br />
<br />
* Radiates to axilla<br />
<br />
* Best heard with the diaphragm of the stethoscope at apex in left lateral [[decubitus]] position<br />
<br />
* Intensity increases with hand grip or squatting <br />
<br />
* Decrease in intensity on standing or [[valsalva maneuver]] <br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* [[P mitrale]] in lead II<br />
* Increased QRS voltage<br />
* [[Right axis deviation]]<br />
* [[Atrial fibrillation]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Acute MR'''<br />
* [[Kerley B lines]]<br />
* No enlargement of cardiac silhouette<br />
'''Chronic MR'''<br />
* Enlarged cardiac silhouette<br />
* Straightening of left heart border<br />
* Splaying of subcarinal angle<br />
* Calcification of mitral annulus<br />
* Double right heart border<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Enlargement of left atrium and ventricle<br />
* Identify valve abnormality<br />
* Valve calcification<br />
* Severity of regurgitation<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Grading of MR is done with left ventriculography<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Decompensated and acute MR may lead to [[heart failure]]<br />
|-<br />
| colspan="10" |<br />
|-<br />
|style="vertical-align: top;background: #DCDCDC; padding: 5px; text-align: center;" |[[Atrial septal defect]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Frequent respiratory or lung infections<br />
* [[Dyspnea]]<br />
* Tiring when feeding (Infants)<br />
* Shortness of breath on exertion<br />
* [[Palpitations]]<br />
* Swelling of feet<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* [[Shortness of breath]]<br />
* [[Fatigue]]<br />
* [[Failure to thrive]]<br />
* Swelling of feet and abdomen ([[Right heart failure]])<br />
* [[Palpitations]]<br />
* Respiratory infections<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Inspection'''<br />
* Precordial bulge<br />
* Precordial lift<br />
'''Palpation'''<br />
* Right ventricular impulse<br />
* Pulmonary artery pulsations<br />
* Thrill<br />
'''Auscultation'''<br />
* Murmur<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Midsystolic (ejection systolic) murmur<br />
<br />
* Widely split, fixed S2<br />
<br />
* Upper left sternal border<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Normal <br />
* Prolonged PR interval<br />
* [[Right bundle branch block]]<br />
* ECG findings varies according to the underlying type of ASD<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
*Increased pulmonary markings<br />
*[[Cardiomegaly]]<br />
*Triangular appearance of heart<br />
*Schimitar sign<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Gold standard test for diagnosis of atrial septal defect (for more information click [[Atrial septal defect echocardiography]])<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Defect size<br />
* Pulmonary venous return<br />
* [[Pulmonary vascular resistance]]<br />
* [[Pulmonary artery hypertension]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Asymptomatic until later part of their life<br />
* May be associated with [[migraine with aura]]<br />
|-<br />
| colspan="10" |<br />
|-<br />
|style="vertical-align: top;background: #DCDCDC; padding: 5px; text-align: center;" |[[Atrial myxoma|Left Atrial Myxoma]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* [[Dyspnea]]<br />
* [[Orthopnea]]<br />
* [[Pulmonary edema]]<br />
* Hyperpigmentation of skin and endocrine activity<br />
* Cerebral [[embolism]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Symptoms may mimic mitral stenosis<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Skin'''<br />
* Signs of an embolic phenomenon<br />
* [[Raynaud's phenomenon]]<br />
* Swelling<br />
* Clubbing<br />
'''Auscultation:'''<br />
* Lung: Fine crepitations <br />
<br />
* Heart: Characteristic "tumor plop" <br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Early diastolic sound as "tumor plop"<br />
<br />
* Low frequency diastolic murmur may be heard if the tumor obstructing mitral valve <br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Often normal<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Often normal<br />
'''Rare findings:'''<br />
* [[cardiomegaly]]<br />
* Left atrial enlargement<br />
* tumor calcification etc.,<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Initial and most useful diagnostic study<br />
* For more information click [[Myxoma echocardiography or ultrasound]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Useful to detect vascular supply of the tumor by the coronary arteries <br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Associated with Carney complex (genetic predisposition)<br />
|-<br />
| colspan="10" |<br />
|-<br />
|style="vertical-align: top;background: #DCDCDC; padding: 5px; text-align: center;" |Prosthetic Valve Obstruction<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* History of valve replacement<br />
* Systemic embolism<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Shortness of breath<br />
* Fatigue<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Ausculation'''<br />
<br />
Muffling of murmur<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Muffling or disappearance of prosthetic sounds<br />
<br />
* Appearance of new regurgitant or obstructive murmur <br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Degree of stenosis<br />
* Assess thrombus size and location<br />
* Differentiate between thrombus, [[pannus]] and vegetations<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |Causes:<br />
* Thrombus<br />
* Pannus formation<br />
|-<br />
| colspan="10" |<br />
|-<br />
|style="vertical-align: top;background: #DCDCDC; padding: 5px; text-align: center;" |[[Cor Triatriatum]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Dyspnea on exertion <br />
* Recent onset of [[congestive heart failure]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Dsypnea on exertion<br />
* Orthopnea<br />
* Tachypnea<br />
* Palpitations<br />
* Growth failure<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Auscultation'''<br />
* Murmur<br />
'''Other findings'''<br />
* Signs of heart failure<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Diastolic murmur with loud P2<br />
<br />
* No opening snap or a loud S1<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |Non specific but may have<br />
* [[Right axis deviation]]<br />
* Right atrial enlargement<br />
* [[Right ventricular hypertrophy]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Normal cardiac silhouette<br />
* Hemodynamic changes similar to mitral stenosis (non specific findings)<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Direct visualization of membrane through the atrium<br />
* +/- visualization of accessory chamber<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Normal left ventricular hemodynamic profile with a trans atrial gradient<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |Types<br />
* Cor triatriatum sinistrum<br />
* Cor triatriatum dextrum<br />
|-<br />
| colspan="10" |<br />
|-<br />
|style="vertical-align: top;background: #DCDCDC; padding: 5px; text-align: center;" |Congenital Mitral Stenosis<br />
| style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Respiratory distress shortly after birth<br />
* Recurrent severe pulmonary infections<br />
* Other associated congenital cardiovascular anamolies<br />
* [[Atrial fibrillation]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
<br />
'''Infants:'''<br />
* Exhaustion and sweating on feeding<br />
* Rapid breathing<br />
* [[Failure to thrive]]<br />
* Pulmonary infections <br />
* Chronic cough<br />
'''Older patients:'''<br />
* Dyspnea<br />
* Orthopnea<br />
* Paroxysmal nocturnal dyspnea<br />
* Peripheral edema<br />
* Fatigue<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Auscultation'''<br />
* Murmur<br />
'''Other findings'''<br />
* Signs of heart failure<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Mild-Moderate'''<br />
* Loud S1<br />
<br />
* Loud P2<br />
<br />
* Low frequency diastolic murmur best heard at the apex <br />
'''Severe'''<br />
* Soft S1<br />
<br />
* Loud pulmonic component of S2 with minimal respiratory splitting of S2 <br />
<br />
* Holodiastolic murmur with presystolic accentuation best heard at the apex <br />
<br />
* Early diastolic murmur of pulmonic valve regurgitation <br />
<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
*Sharp P waves in leads I and II<br />
*Inversion of P wave in lead III<br />
*Marked Q waves in leads II and III<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Left atrial dilation<br />
* Moderate enlargement of right heart<br />
* Pulmonary venous congestion<br />
* Esophageal compression<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Reduced valve leaflet mobility<br />
* Left atrial size<br />
* Severity of mitral stenosis<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |Very rare condition<br />
|-<br />
| colspan="10" |<br />
|-<br />
|style="vertical-align: top;background: #DCDCDC; padding: 5px; text-align: center;" |Supravalvular Ring Mitral Stenosis<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Other associated congenital heart defects<br />
* Fatigue<br />
* Frequent respiratory infections<br />
* Failure to thrive<br />
* Poor feeding<br />
* Precocious congestive heart failure <br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Shortness of breath<br />
<br />
* Tachypnea<br />
* Dyspnea<br />
* Nocturnal cough<br />
* Heamoptysis<br />
* [[Syncope]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Auscultation:'''<br />
<br />
Lungs: Fine, crepitant rales and rhonchi or wheezes may be present<br />
<br />
Heart: Murmur<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* An apical mid diastolic murmur with presystolic accentuation<br />
<br />
* No opening snap<br />
<br />
* The murmur is more prominent if associated with [[VSD]] or [[PDA]]<br />
<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Left atrial and ventricular enlargement<br />
* Alveolar edema <br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Supramitral ring''':<br />
* Associated with normal mitral valve apparatus<br />
'''Intramitral ring:'''<br />
* Hypomobility of the posterior leaflet<br />
* Reduced interpapillary muscle distance<br />
* Reduced chordal length<br />
* Dominant papillary muscle<br />
* Hypoplastic mitral annulus<br />
(Difficult to visualize membrane <1mm in size)<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Persistently elevated pulmonary venous pressures<br />
* Increased pulmonary artery pressure<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Types'''<br />
* Supramitral<br />
* Intramitral<br />
It is attached between the opening of the atrial appendage and the mitral annulus which helps in differentiating with Cor triatriatum sinister.<br />
* Intramitral type is associated with shone complex<br />
|}</div>
Ifeoma odukwe
https://www.wikidoc.org/index.php?title=Sandbox:_Ifeoma&diff=1608427
Sandbox: Ifeoma
2020-05-16T15:52:29Z
<p>Ifeoma odukwe: </p>
<hr />
<div>Wikidoc practice session<br />
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{{cquote|I can't wait for covid to be over!}}<br />
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==Classification of dextrocardia==<br />
{| style="border: 0px; font-size: 90%; margin: 3px; width: 1000px"<br />
|valign=top|<br />
|+<br />
! style="background: #4479BA; width: 250px; color: #FFFFFF;"|'''Dextrocardia Types'''<br />
<br />
! style="background: #4479BA; width: 600px; color: #FFFFFF;"|'''Description'''<br />
<br />
|-<br />
<br />
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align=center | '''Dextrocardia with situs solitus '''|| style="padding: 5px 5px; background: #F5F5F5;" |<br />
:* Dextrocardia with normally related great arteries and D-transposition (complete transposition) or L-transposition (congenitally corrected transposition) of the great arteries. Some examples include dextrocardia with D-loop ventricles and normally related great arteries, with L-loop ventricles and L-TGA (congenitally corrected TGA).<br />
:* Embryologic failure of the final leftward shift of the ventricles during development results in dextrocardia with situs solitus, D-loop ventricles, and normally related great arteries.<br />
<br />
|-<br />
<br />
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align=center | '''Dextrocardia with situs inversus '''|| style="padding: 5px 5px; background: #F5F5F5;"|<br />
:* May present with dextrocardia with inversely related great arteries and D-transposition (congenitally corrected transposition) or L-transposition (“uncorrected” transposition) of the great arteries. An example is dextrocardia with D-loop ventricles and D-TGA (congenitally corrected TGA).<br />
<br />
|-<br />
<br />
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align=center | '''Dextrocardia with situs ambiguous (either polyspenia or asplenia)''' || style="padding: 5px 5px; background: #F5F5F5;"|<br />
:* Dextrocardia with any of the above relationships between the ventricles and great vessels.<br />
<br />
|-<br />
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<br />
{|<br />
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"<br />
! rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;|Diseases<br />
| colspan="6" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;|'''Clinical manifestations'''<br />
! colspan="3" rowspan="2" |Para-clinical findings<br />
| colspan="1" rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;|'''Gold standard'''<br />
! rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;|Additional findings<br />
|-<br />
| colspan="3" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;|'''Symptoms'''<br />
! colspan="3" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;|Physical examination<br />
|-<br />
! colspan="3" style="background: #4479BA; color: #FFFFFF; text-align: center;|Imaging<br />
|- <br />
! style="background: #4479BA; color: #FFFFFF; text-align: center;|Exertional dyspnea<br />
! colspan="1" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;|Failure to thrive<br />
! style="background: #4479BA; color: #FFFFFF; text-align: center;|Recurrent respiratory infections<br />
! style="background: #4479BA; color: #FFFFFF; text-align: center;|Murmur on auscultation<br />
! colspan="1" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;|Peripheral edema<br />
! style="background: #4479BA; color: #FFFFFF; text-align: center;|Clubbing<br />
! style="background: #4479BA; color: #FFFFFF; text-align: center;|Echocardiography<br />
! style="background: #4479BA; color: #FFFFFF; text-align: center;|Chest x-ray<br />
! style="background: #4479BA; color: #FFFFFF; text-align: center;|Cardiac CT<br />
|-<br />
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Patent foramen ovale]]<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Appearance of at least 3 micro-bubbles in the left atrium within three cardiac cycles after complete opacification of the right atrium<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | Non specific<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | <br />
* A contrast agent jet from the left atrium to the right atrium toward the inferior vena cava with channel-like appearance of the interatrial septum<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Echocardiogram<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* It is associated with paradoxical embolism, migraine headache, and decompression sickness in divers<br />
|-<br />
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Atrial septal defect]]<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/−<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/−<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/− <br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Systolic flow murmur in the upper left sternal border<br />
* Wide, fixed splitting of S2<br />
* Diastolic flow rumble across the tricuspid valve<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/−<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/−<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Hypermobile interatrial septum<br />
* Abrupt septal irregularity<br />
* Right atrial and ventricular volume overload<br />
* Pulmonary artery dilatation<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Cardiomegaly <br />
* Pulmonary artery enlargement/increased pulmonary vascularity<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Enlargement of the right atrium and ventricle<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Echocardiogram<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Atrial septal defect is classified into 5 types including ostium primum defect, ostium secundum defect, superior sinus venosus defect, inferior sinus venosus defect, and coronary sinus defect<br />
|-<br />
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Ventricular septal defect]]<br />
| style="background: #F5F5F5; padding: 5px;" |-/+<br />
| style="background: #F5F5F5; padding: 5px;" |-/+<br />
| style="background: #F5F5F5; padding: 5px;" |After Eisenmenger syndrome<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Holosystolic murmur<br />
* May mimic aortic stenosis(mid/end dyastolic murmur due to increased pulmonary circulation)<br />
| style="background: #F5F5F5; padding: 5px;" |-/+<br />
| style="background: #F5F5F5; padding: 5px;" |-/+<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Defect localization<br />
*septal dropout in the area adjacent to the tricuspid septal leaflet and below the right border of the aortic annulus<br />
* Direction of jet<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* [[Cardiomegaly]] in large VSD<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Direct visualisation of murmur<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Echocardiogram<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"<br />
!Diseases<br />
!Exertional dyspnea<br />
! colspan="1" rowspan="1" |Failure to thrive<br />
!Recurrent respiratory infections<br />
!Murmur on auscultation<br />
! colspan="1" rowspan="1" |Peripheral edema<br />
!Clubbing<br />
!Echocardiography<br />
!Chest x-ray<br />
!Cardiac CT<br />
|'''Gold standard'''<br />
!Additional findings<br />
|-<br />
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Patent ductus arteriosus]]<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Not at beginning<br />
* May be produced during the course of disease <br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Depends on the size<br />
| style="background: #F5F5F5; padding: 5px;" | -<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Continuous machine-like murmur<br />
| style="background: #F5F5F5; padding: 5px;" |-<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* May be present by progressing<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Golden standard <br />
* In color-Doppler visualization of flow through the patent duct which has a high velocity<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Non-specific<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Used for determining Krichenko classification<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Echocardiogram<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Krichenko criteria for classification is a very important factor for treatment<br />
|-<br />
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Aortic coarctation|Coarctation of the aorta]]<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/−<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/−<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Systolic murmur over the upper sternal border with radiation to the back<br />
*Murmur of mitral regurgitation (holosystolic murmur best heard at the apex)<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Narrowing of the aortic arch at the level of the isthmus<br />
* Left ventricular hypertrophy<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Notching of the posterior fourth to eighth ribs due to dilated intercostal arteries<br />
* Indentation of the aorta at the site of coarctation with pre- and post-stenotic dilation of the aorta (classic "3 sign")<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Dilation of the intercostal arteries<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Echocardiogram<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
*Patients present with arm-leg blood pressure gradient of >20mmHg<br />
|-<br />
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Aortic stenosis]]<br />
| style="background: #F5F5F5; padding: 5px;" |+<br />
| style="background: #F5F5F5; padding: 5px;" |+<br />
| style="background: #F5F5F5; padding: 5px;" |+<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Crescendo-decrescendo mid-systolic (or ejection systolic) murmur<br />
| style="background: #F5F5F5; padding: 5px;" |+/-<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Depending on severity<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Used for finding the location of stenosis<br />
* Finding severity<br />
* Evaluating the flow jet with color-Doppler ultrasound technique<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Non-specific at the beginning<br />
* At progressed stage calcification of the valve and cardiomegally<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
*[[Aortic calcification|Calcification score]]<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* MRI<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* MRI provides a more detailed structural and dynamic assessment of the aortic valve and left ventricle, in particular<br />
|-<br />
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Pulmonary valve stenosis|Pulmonary stenosis]]<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Depending on severity<br />
| style="background: #F5F5F5; padding: 5px;" | -<br />
| style="background: #F5F5F5; padding: 5px;" | -/+<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Continuous systolic murmur<br />
| style="background: #F5F5F5; padding: 5px;" |-<br />
| style="background: #F5F5F5; padding: 5px;" | -/+<br />
| style="background: #F5F5F5; padding: 5px;" | <br />
* Right atrial hypertrophy<br />
| style="background: #F5F5F5; padding: 5px;" | <br />
* Non-specific<br />
| style="background: #F5F5F5; padding: 5px;" | <br />
* Direct visualization of stenosis<br />
| style="background: #F5F5F5; padding: 5px;" | <br />
* Echocardiogram<br />
| style="background: #F5F5F5; padding: 5px;" | <br />
|}<br />
<br />
<br />
<br />
<br />
<br />
<br />
<br />
<br />
<br />
<br />
<br />
{| class="wikitable"<br />
|+<br />
!Diseases<br />
!Pathophysiology<br />
!Shunt<br />
!Symptoms<br />
!Diagnosis<br />
!Echocardiography findings<br />
!Physical examination<br />
!Treatment<br />
!Complications<br />
|-<br />
|Patent foramen ovale<br />
|<br />
* Failure of fusion of the septum primum and septum secundum leading to a flap valve opening.<br />
|<br />
* Right-to-left shunt<br />
<br />
* More prominent with increased right atrial pressure.<br />
|<br />
* Majority of patients are asymptomatic<br />
|<br />
* TEE (Gold standard)<br />
<br />
* TTE<br />
<br />
* TCD<br />
|<br />
* Appearance of at least 3 micro-bubbles in the left atrium within three cardiac cycles after the complete opacification of the right atrium<br />
|<br />
|<br />
* Percutaneous closure<br />
* Anticoagulants<br />
* Antiplatelets<br />
|<br />
* Paradoxical embolism<br />
<br />
* Migraine with aura<br />
*Decompression sickness in divers<br />
*Platypnea-orthodeoxia syndrome<br /><br />
|-<br />
|Atrial septal defect<br />
|<br />
* '''Ostium secundum defect''': Failure of the septum secundum to occlude the ostium secundum.<br />
<br />
* '''Ostium primum defect''': Failure of the ostium primum to fuse with the endocardial cushions.<br />
<br />
* '''Superior sinus venosus defect''': The orifice of the superior vena cava overrides the atrial septum above the fossa ovalis.<br />
<br />
* '''Inferior sinus venosus defect''': The orifice of the inferior vena cava overrides the left and right atrium.<br />
*'''Coronary sinus defect''': Absence of a portion of the common wall that separates the coronary sinus and the left atrium.<br />
|<br />
* Continuous left-to-right shunt<br />
|<br />
* Failure to thrive, tachypnea, recurrent respiratory infections, heart failure<br />
<br />
* Commonly asymptomatic during childhood and adolescence<br />
*Adults with large shunts may become symptomatic in the fourth decade presenting with fatigue, exercise intolerance, palpitations, syncope, and shortness of breath.<br />
<br />
*<br />
|<br />
* TTE (Gold standard)<br />
*Cardiac CT<br />
*Cardiac MRI<br />
|<br />
* Hypermobile interatrial septum<br />
* Abrupt septal irregularity<br />
* Right atrial and ventricular volume overload<br />
* Pulmonary artery dilation<br />
*'''Coronary sinus defect''': Enlarged ostium of the coronary sinus and unroofing of the terminal portion of the coronary sinus<br />
|<br />
* Systolic flow murmur in the pulmonary valve region<br />
*Wide, fixed splitting of S2<br />
*Diastolic flow rumble across the tricuspid valve<br />
*Right ventricular heave <br />
|<br />
* Spontaneous closure<br />
*Percutaneous transcatheter closure<br />
*Surgical closure<br />
|<br />
* Right sided heart failure<br />
* Peripheral edema<br />
* Eisenmenger syndrome (cyanosis)<br />
* Paradoxical emboli<br />
* Pulmonary hypertension<br />
|-<br />
|Pulmonary ateriovenous fistula<br />
|<br />
* Abnormal blood vessel(s) connecting the pulmonary arteries and veins directly without interposition of pulmonary capillaries<br />
|<br />
* Right-to-left shunt between the pulmonary artery and pulmonary vein<br />
|<br />
* Symptoms may occur only after the second decade<br />
*Cyanosis<br />
*Hemoptysis<br />
|<br />
* Chest CT<br />
*Pulmonary arteriogram<br />
|<br />
* Appearance of contrast bubbles in the left atrium three to five cardiac cycles after appearance in the right atrium<br />
|<br />
* Clubbing<br />
*Systolic/continuous murmur<br />
|<br />
* Embolization<br />
* Surgical resection<br />
|<br />
* Cerebral ischemia/abscess<br />
*Hemothorax<br />
|}<br />
<br />
==Differential table for aortic stenosis==<br />
<br />
{| class="wikitable"<br />
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;|Diseases<br />
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;|History<br />
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;|Symptoms<br />
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;|Physical Examination<br />
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;|Murmur<br />
! colspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;|Diagnosis<br />
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;|Other Findings<br />
|- style="background: #DCDCDC; padding: 5px; text-align: center;"<br />
!style="background: #4479BA; color: #FFFFFF; text-align: center;|ECG<br />
!style="background: #4479BA; color: #FFFFFF; text-align: center;|CXR<br />
!style="background: #4479BA; color: #FFFFFF; text-align: center;|Echocardiogram<br />
!style="background: #4479BA; color: #FFFFFF; text-align: center;|Cardiac Catheterization<br />
|-<br />
|style="background: #DCDCDC; padding: 5px; text-align: center;" |Aortic stenosis<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Age (aortic valve calcification)<br />
*Syncope<br />
*Orthopnea<br />
*Paroxysmal nocturnal dyspnea<br />
*Acute rheumatic fever<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Chest pain<br />
*Dyspnea on exertion<br />
*Palpitations<br />
*Symptoms of heart failure<br />
| style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Pulsus parvus et tardus<br />
*Pulmonary rales<br />
*Peripheral edema (In CHF patients)<br />
*Jugular venous distension<br />
*Enlarged and laterally displaced point of maximal impulse<br />
<br />
*<br />
| style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Crescendo-decrescendo systolic murmur<br />
*Best heard at the right upper sternal border<br />
*Radiation to the carotid arteries<br />
*Increases with squatting<br />
*Decreases with valsalva maneuver<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Left ventricular hypertrophy''':<br />
<br />
* Wide QRS complex (especially in leads V1-V6)<br />
*ST depression in leads V5-V6<br />
*Left axis deviation<br />
* <br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Enlarged left ventricle<br />
* Enlarged left atrium and pulmonary artery in severe cases<br />
*Calcification of the aortic valve<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Thickening and calcification of the aortic valve<br />
*Left ventricular hypertrophy<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Left heart catheterization:'''<br />
<br />
* Left ventricular and aortic pressures<br />
*The left ventricle generates higher pressures than what is transmitted to the aorta<br />
| style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Associated with von Willibrand disease<br />
|-<br />
| colspan="10" |<br />
|-<br />
|style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Mitral Stenosis]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Age ( Mitral annular calcification in older patients)<br />
<br />
* [[Rheumatic fever]]<br />
<br />
* [[Endocarditis]]<br />
<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* [[Dyspnea on exertion]]<br />
<br />
* [[Paroxysmal nocturnal dyspnea]]<br />
<br />
* [[Orthopnea]]<br />
<br />
* New onset [[atrial fibrillation]]<br />
<br />
| style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Mitral facies<br />
<br />
* Heart murmur<br />
<br />
* [[JVD|Jugular vein distension]]<br />
<br />
* Apical impulse displaced laterally or not palpable <br />
<br />
* Diastolic thrill at the apex <br />
<br />
* Signs of heart failure in severe cases<br />
| style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Diastolic murmur<br />
<br />
* Low pitched<br />
<br />
* Opening snap followed by decrescendo-crescendo rumbling murmur <br />
<br />
* Best heard with the bell of the stethoscope at apex at end-expiration in left lateral decubitus position <br />
<br />
* Intensity increases after a [[valsalva maneuver]], after exercise and after increased after load (eg., squatting, isometric hand grip) <br />
| style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* [[P mitrale]]<br />
* [[Atrial fibrillation]]: No P waves and irregularly irregular rhythm<br />
<br />
* [[Right axis deviation]]<br />
<br />
* Right ventricular hypertropy: Dominant R wave in V1 and V2<br />
| style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Straightening of the left border of the heart suggestive of enlargement of the [[left atrium]]<br />
<br />
* Double right heart border (Enlarged left atrium and normal right atrium) <br />
<br />
* Prominent left atrial appendage<br />
<br />
* Splaying of [[carina|subcarinal angle]] (>120 degrees)<br />
<br />
* Calcification of [[mitral valve]]<br />
<br />
* [[Kerley B lines]] <br />
<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Reduced valve leaflet mobility<br />
<br />
* Valve calcification <br />
<br />
* Doming of mitral valve<br />
<br />
* Valve thickening <br />
* Enlargement of left atrium <br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Right heart catheterization:'''<br />
* [[Pulmonary capillary wedge pressure]] (left atrial pressure) <br />
'''Left heart catheterization:'''<br />
* Pressures in left ventricle<br />
<br />
* Determines the gradient between the left and right atrium during ventricular diastole (marker of the severity of mitral stenosis)<br />
<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* [[Hemoptysis]] ([[heart failure]])<br />
<br />
* [[Ortner's syndrome]]<br />
|-<br />
| colspan="10" |<br />
|-<br />
|style="vertical-align: top;background: #DCDCDC; padding: 5px; text-align: center;" |[[Mitral Regurgitation]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* [[CAD]]<br />
<br />
* [[MI]]<br />
<br />
* [[Rheumatic fever]]<br />
<br />
* [[Endocarditis]]<br />
<br />
* [[Mitral valve prolapse]]<br />
<br />
* [[Cardiomyopathy]]<br />
<br />
* [[Radiation therapy]]<br />
<br />
* Trauma<br />
<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* [[Palpitations]]<br />
<br />
* Symptoms of heart failure in severe cases<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Palpation'''<br />
* Brisk carotid upstroke and hyperdymanic carotid impulse on palpation<br />
<br />
* Apical impulse is displaced to left<br />
<br />
* S3 and a palpable thrill<br />
'''Auscultation'''<br />
* Murmur<br />
<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* [[Holosystolic murmur]]<br />
<br />
* High pitched, blowing<br />
<br />
* Radiates to axilla<br />
<br />
* Best heard with the diaphragm of the stethoscope at apex in left lateral [[decubitus]] position<br />
<br />
* Intensity increases with hand grip or squatting <br />
<br />
* Decrease in intensity on standing or [[valsalva maneuver]] <br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* [[P mitrale]] in lead II<br />
* Increased QRS voltage<br />
* [[Right axis deviation]]<br />
* [[Atrial fibrillation]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Acute MR'''<br />
* [[Kerley B lines]]<br />
* No enlargement of cardiac silhouette<br />
'''Chronic MR'''<br />
* Enlarged cardiac silhouette<br />
* Straightening of left heart border<br />
* Splaying of subcarinal angle<br />
* Calcification of mitral annulus<br />
* Double right heart border<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Enlargement of left atrium and ventricle<br />
* Identify valve abnormality<br />
* Valve calcification<br />
* Severity of regurgitation<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Grading of MR is done with left ventriculography<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Decompensated and acute MR may lead to [[heart failure]]<br />
|-<br />
| colspan="10" |<br />
|-<br />
|style="vertical-align: top;background: #DCDCDC; padding: 5px; text-align: center;" |[[Atrial septal defect]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Frequent respiratory or lung infections<br />
* [[Dyspnea]]<br />
* Tiring when feeding (Infants)<br />
* Shortness of breath on exertion<br />
* [[Palpitations]]<br />
* Swelling of feet<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* [[Shortness of breath]]<br />
* [[Fatigue]]<br />
* [[Failure to thrive]]<br />
* Swelling of feet and abdomen ([[Right heart failure]])<br />
* [[Palpitations]]<br />
* Respiratory infections<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Inspection'''<br />
* Precordial bulge<br />
* Precordial lift<br />
'''Palpation'''<br />
* Right ventricular impulse<br />
* Pulmonary artery pulsations<br />
* Thrill<br />
'''Auscultation'''<br />
* Murmur<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Midsystolic (ejection systolic) murmur<br />
<br />
* Widely split, fixed S2<br />
<br />
* Upper left sternal border<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Normal <br />
* Prolonged PR interval<br />
* [[Right bundle branch block]]<br />
* ECG findings varies according to the underlying type of ASD<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
*Increased pulmonary markings<br />
*[[Cardiomegaly]]<br />
*Triangular appearance of heart<br />
*Schimitar sign<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Gold standard test for diagnosis of atrial septal defect (for more information click [[Atrial septal defect echocardiography]])<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Defect size<br />
* Pulmonary venous return<br />
* [[Pulmonary vascular resistance]]<br />
* [[Pulmonary artery hypertension]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Asymptomatic until later part of their life<br />
* May be associated with [[migraine with aura]]<br />
|-<br />
| colspan="10" |<br />
|-<br />
|style="vertical-align: top;background: #DCDCDC; padding: 5px; text-align: center;" |[[Atrial myxoma|Left Atrial Myxoma]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* [[Dyspnea]]<br />
* [[Orthopnea]]<br />
* [[Pulmonary edema]]<br />
* Hyperpigmentation of skin and endocrine activity<br />
* Cerebral [[embolism]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Symptoms may mimic mitral stenosis<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Skin'''<br />
* Signs of an embolic phenomenon<br />
* [[Raynaud's phenomenon]]<br />
* Swelling<br />
* Clubbing<br />
'''Auscultation:'''<br />
* Lung: Fine crepitations <br />
<br />
* Heart: Characteristic "tumor plop" <br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Early diastolic sound as "tumor plop"<br />
<br />
* Low frequency diastolic murmur may be heard if the tumor obstructing mitral valve <br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Often normal<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Often normal<br />
'''Rare findings:'''<br />
* [[cardiomegaly]]<br />
* Left atrial enlargement<br />
* tumor calcification etc.,<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Initial and most useful diagnostic study<br />
* For more information click [[Myxoma echocardiography or ultrasound]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Useful to detect vascular supply of the tumor by the coronary arteries <br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Associated with Carney complex (genetic predisposition)<br />
|-<br />
| colspan="10" |<br />
|-<br />
|style="vertical-align: top;background: #DCDCDC; padding: 5px; text-align: center;" |Prosthetic Valve Obstruction<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* History of valve replacement<br />
* Systemic embolism<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Shortness of breath<br />
* Fatigue<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Ausculation'''<br />
<br />
Muffling of murmur<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Muffling or disappearance of prosthetic sounds<br />
<br />
* Appearance of new regurgitant or obstructive murmur <br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Degree of stenosis<br />
* Assess thrombus size and location<br />
* Differentiate between thrombus, [[pannus]] and vegetations<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |Causes:<br />
* Thrombus<br />
* Pannus formation<br />
|-<br />
| colspan="10" |<br />
|-<br />
|style="vertical-align: top;background: #DCDCDC; padding: 5px; text-align: center;" |[[Cor Triatriatum]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Dyspnea on exertion <br />
* Recent onset of [[congestive heart failure]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Dsypnea on exertion<br />
* Orthopnea<br />
* Tachypnea<br />
* Palpitations<br />
* Growth failure<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Auscultation'''<br />
* Murmur<br />
'''Other findings'''<br />
* Signs of heart failure<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Diastolic murmur with loud P2<br />
<br />
* No opening snap or a loud S1<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |Non specific but may have<br />
* [[Right axis deviation]]<br />
* Right atrial enlargement<br />
* [[Right ventricular hypertrophy]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Normal cardiac silhouette<br />
* Hemodynamic changes similar to mitral stenosis (non specific findings)<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Direct visualization of membrane through the atrium<br />
* +/- visualization of accessory chamber<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Normal left ventricular hemodynamic profile with a trans atrial gradient<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |Types<br />
* Cor triatriatum sinistrum<br />
* Cor triatriatum dextrum<br />
|-<br />
| colspan="10" |<br />
|-<br />
|style="vertical-align: top;background: #DCDCDC; padding: 5px; text-align: center;" |Congenital Mitral Stenosis<br />
| style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Respiratory distress shortly after birth<br />
* Recurrent severe pulmonary infections<br />
* Other associated congenital cardiovascular anamolies<br />
* [[Atrial fibrillation]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
<br />
'''Infants:'''<br />
* Exhaustion and sweating on feeding<br />
* Rapid breathing<br />
* [[Failure to thrive]]<br />
* Pulmonary infections <br />
* Chronic cough<br />
'''Older patients:'''<br />
* Dyspnea<br />
* Orthopnea<br />
* Paroxysmal nocturnal dyspnea<br />
* Peripheral edema<br />
* Fatigue<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Auscultation'''<br />
* Murmur<br />
'''Other findings'''<br />
* Signs of heart failure<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Mild-Moderate'''<br />
* Loud S1<br />
<br />
* Loud P2<br />
<br />
* Low frequency diastolic murmur best heard at the apex <br />
'''Severe'''<br />
* Soft S1<br />
<br />
* Loud pulmonic component of S2 with minimal respiratory splitting of S2 <br />
<br />
* Holodiastolic murmur with presystolic accentuation best heard at the apex <br />
<br />
* Early diastolic murmur of pulmonic valve regurgitation <br />
<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
*Sharp P waves in leads I and II<br />
*Inversion of P wave in lead III<br />
*Marked Q waves in leads II and III<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Left atrial dilation<br />
* Moderate enlargement of right heart<br />
* Pulmonary venous congestion<br />
* Esophageal compression<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Reduced valve leaflet mobility<br />
* Left atrial size<br />
* Severity of mitral stenosis<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |Very rare condition<br />
|-<br />
| colspan="10" |<br />
|-<br />
|style="vertical-align: top;background: #DCDCDC; padding: 5px; text-align: center;" |Supravalvular Ring Mitral Stenosis<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Other associated congenital heart defects<br />
* Fatigue<br />
* Frequent respiratory infections<br />
* Failure to thrive<br />
* Poor feeding<br />
* Precocious congestive heart failure <br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Shortness of breath<br />
<br />
* Tachypnea<br />
* Dyspnea<br />
* Nocturnal cough<br />
* Heamoptysis<br />
* [[Syncope]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Auscultation:'''<br />
<br />
Lungs: Fine, crepitant rales and rhonchi or wheezes may be present<br />
<br />
Heart: Murmur<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* An apical mid diastolic murmur with presystolic accentuation<br />
<br />
* No opening snap<br />
<br />
* The murmur is more prominent if associated with [[VSD]] or [[PDA]]<br />
<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Left atrial and ventricular enlargement<br />
* Alveolar edema <br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Supramitral ring''':<br />
* Associated with normal mitral valve apparatus<br />
'''Intramitral ring:'''<br />
* Hypomobility of the posterior leaflet<br />
* Reduced interpapillary muscle distance<br />
* Reduced chordal length<br />
* Dominant papillary muscle<br />
* Hypoplastic mitral annulus<br />
(Difficult to visualize membrane <1mm in size)<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Persistently elevated pulmonary venous pressures<br />
* Increased pulmonary artery pressure<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Types'''<br />
* Supramitral<br />
* Intramitral<br />
It is attached between the opening of the atrial appendage and the mitral annulus which helps in differentiating with Cor triatriatum sinister.<br />
* Intramitral type is associated with shone complex<br />
|}</div>
Ifeoma odukwe
https://www.wikidoc.org/index.php?title=Sandbox:_Ifeoma&diff=1608426
Sandbox: Ifeoma
2020-05-16T15:47:16Z
<p>Ifeoma odukwe: /* Physiology */</p>
<hr />
<div>Wikidoc practice session<br />
<br />
==Pathophysiology==<br />
===Physiology===<br />
* Physiology shows you how you work.<br />
:* And how it operates<br />
<br />
# Ifeoma<br />
## Boston<br />
## Massachusetts<br />
# Ifrah<br />
# Zaida <br />
# Beenish<br />
<br />
==Classification of dextrocardia==<br />
{| style="border: 0px; font-size: 90%; margin: 3px; width: 1000px"<br />
|valign=top|<br />
|+<br />
! style="background: #4479BA; width: 250px; color: #FFFFFF;"|'''Dextrocardia Types'''<br />
<br />
! style="background: #4479BA; width: 600px; color: #FFFFFF;"|'''Description'''<br />
<br />
|-<br />
<br />
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align=center | '''Dextrocardia with situs solitus '''|| style="padding: 5px 5px; background: #F5F5F5;" |<br />
:* Dextrocardia with normally related great arteries and D-transposition (complete transposition) or L-transposition (congenitally corrected transposition) of the great arteries. Some examples include dextrocardia with D-loop ventricles and normally related great arteries, with L-loop ventricles and L-TGA (congenitally corrected TGA).<br />
:* Embryologic failure of the final leftward shift of the ventricles during development results in dextrocardia with situs solitus, D-loop ventricles, and normally related great arteries.<br />
<br />
|-<br />
<br />
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align=center | '''Dextrocardia with situs inversus '''|| style="padding: 5px 5px; background: #F5F5F5;"|<br />
:* May present with dextrocardia with inversely related great arteries and D-transposition (congenitally corrected transposition) or L-transposition (“uncorrected” transposition) of the great arteries. An example is dextrocardia with D-loop ventricles and D-TGA (congenitally corrected TGA).<br />
<br />
|-<br />
<br />
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align=center | '''Dextrocardia with situs ambiguous (either polyspenia or asplenia)''' || style="padding: 5px 5px; background: #F5F5F5;"|<br />
:* Dextrocardia with any of the above relationships between the ventricles and great vessels.<br />
<br />
|-<br />
<br />
<br />
{|<br />
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"<br />
! rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;|Diseases<br />
| colspan="6" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;|'''Clinical manifestations'''<br />
! colspan="3" rowspan="2" |Para-clinical findings<br />
| colspan="1" rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;|'''Gold standard'''<br />
! rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;|Additional findings<br />
|-<br />
| colspan="3" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;|'''Symptoms'''<br />
! colspan="3" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;|Physical examination<br />
|-<br />
! colspan="3" style="background: #4479BA; color: #FFFFFF; text-align: center;|Imaging<br />
|- <br />
! style="background: #4479BA; color: #FFFFFF; text-align: center;|Exertional dyspnea<br />
! colspan="1" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;|Failure to thrive<br />
! style="background: #4479BA; color: #FFFFFF; text-align: center;|Recurrent respiratory infections<br />
! style="background: #4479BA; color: #FFFFFF; text-align: center;|Murmur on auscultation<br />
! colspan="1" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;|Peripheral edema<br />
! style="background: #4479BA; color: #FFFFFF; text-align: center;|Clubbing<br />
! style="background: #4479BA; color: #FFFFFF; text-align: center;|Echocardiography<br />
! style="background: #4479BA; color: #FFFFFF; text-align: center;|Chest x-ray<br />
! style="background: #4479BA; color: #FFFFFF; text-align: center;|Cardiac CT<br />
|-<br />
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Patent foramen ovale]]<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Appearance of at least 3 micro-bubbles in the left atrium within three cardiac cycles after complete opacification of the right atrium<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | Non specific<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | <br />
* A contrast agent jet from the left atrium to the right atrium toward the inferior vena cava with channel-like appearance of the interatrial septum<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Echocardiogram<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* It is associated with paradoxical embolism, migraine headache, and decompression sickness in divers<br />
|-<br />
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Atrial septal defect]]<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/−<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/−<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/− <br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Systolic flow murmur in the upper left sternal border<br />
* Wide, fixed splitting of S2<br />
* Diastolic flow rumble across the tricuspid valve<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/−<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/−<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Hypermobile interatrial septum<br />
* Abrupt septal irregularity<br />
* Right atrial and ventricular volume overload<br />
* Pulmonary artery dilatation<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Cardiomegaly <br />
* Pulmonary artery enlargement/increased pulmonary vascularity<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Enlargement of the right atrium and ventricle<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Echocardiogram<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Atrial septal defect is classified into 5 types including ostium primum defect, ostium secundum defect, superior sinus venosus defect, inferior sinus venosus defect, and coronary sinus defect<br />
|-<br />
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Ventricular septal defect]]<br />
| style="background: #F5F5F5; padding: 5px;" |-/+<br />
| style="background: #F5F5F5; padding: 5px;" |-/+<br />
| style="background: #F5F5F5; padding: 5px;" |After Eisenmenger syndrome<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Holosystolic murmur<br />
* May mimic aortic stenosis(mid/end dyastolic murmur due to increased pulmonary circulation)<br />
| style="background: #F5F5F5; padding: 5px;" |-/+<br />
| style="background: #F5F5F5; padding: 5px;" |-/+<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Defect localization<br />
*septal dropout in the area adjacent to the tricuspid septal leaflet and below the right border of the aortic annulus<br />
* Direction of jet<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* [[Cardiomegaly]] in large VSD<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Direct visualisation of murmur<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Echocardiogram<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"<br />
!Diseases<br />
!Exertional dyspnea<br />
! colspan="1" rowspan="1" |Failure to thrive<br />
!Recurrent respiratory infections<br />
!Murmur on auscultation<br />
! colspan="1" rowspan="1" |Peripheral edema<br />
!Clubbing<br />
!Echocardiography<br />
!Chest x-ray<br />
!Cardiac CT<br />
|'''Gold standard'''<br />
!Additional findings<br />
|-<br />
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Patent ductus arteriosus]]<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Not at beginning<br />
* May be produced during the course of disease <br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Depends on the size<br />
| style="background: #F5F5F5; padding: 5px;" | -<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Continuous machine-like murmur<br />
| style="background: #F5F5F5; padding: 5px;" |-<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* May be present by progressing<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Golden standard <br />
* In color-Doppler visualization of flow through the patent duct which has a high velocity<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Non-specific<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Used for determining Krichenko classification<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Echocardiogram<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Krichenko criteria for classification is a very important factor for treatment<br />
|-<br />
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Aortic coarctation|Coarctation of the aorta]]<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/−<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/−<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Systolic murmur over the upper sternal border with radiation to the back<br />
*Murmur of mitral regurgitation (holosystolic murmur best heard at the apex)<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Narrowing of the aortic arch at the level of the isthmus<br />
* Left ventricular hypertrophy<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Notching of the posterior fourth to eighth ribs due to dilated intercostal arteries<br />
* Indentation of the aorta at the site of coarctation with pre- and post-stenotic dilation of the aorta (classic "3 sign")<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Dilation of the intercostal arteries<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Echocardiogram<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
*Patients present with arm-leg blood pressure gradient of >20mmHg<br />
|-<br />
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Aortic stenosis]]<br />
| style="background: #F5F5F5; padding: 5px;" |+<br />
| style="background: #F5F5F5; padding: 5px;" |+<br />
| style="background: #F5F5F5; padding: 5px;" |+<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Crescendo-decrescendo mid-systolic (or ejection systolic) murmur<br />
| style="background: #F5F5F5; padding: 5px;" |+/-<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Depending on severity<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Used for finding the location of stenosis<br />
* Finding severity<br />
* Evaluating the flow jet with color-Doppler ultrasound technique<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Non-specific at the beginning<br />
* At progressed stage calcification of the valve and cardiomegally<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
*[[Aortic calcification|Calcification score]]<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* MRI<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* MRI provides a more detailed structural and dynamic assessment of the aortic valve and left ventricle, in particular<br />
|-<br />
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Pulmonary valve stenosis|Pulmonary stenosis]]<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Depending on severity<br />
| style="background: #F5F5F5; padding: 5px;" | -<br />
| style="background: #F5F5F5; padding: 5px;" | -/+<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Continuous systolic murmur<br />
| style="background: #F5F5F5; padding: 5px;" |-<br />
| style="background: #F5F5F5; padding: 5px;" | -/+<br />
| style="background: #F5F5F5; padding: 5px;" | <br />
* Right atrial hypertrophy<br />
| style="background: #F5F5F5; padding: 5px;" | <br />
* Non-specific<br />
| style="background: #F5F5F5; padding: 5px;" | <br />
* Direct visualization of stenosis<br />
| style="background: #F5F5F5; padding: 5px;" | <br />
* Echocardiogram<br />
| style="background: #F5F5F5; padding: 5px;" | <br />
|}<br />
<br />
<br />
<br />
<br />
<br />
<br />
<br />
<br />
<br />
<br />
<br />
{| class="wikitable"<br />
|+<br />
!Diseases<br />
!Pathophysiology<br />
!Shunt<br />
!Symptoms<br />
!Diagnosis<br />
!Echocardiography findings<br />
!Physical examination<br />
!Treatment<br />
!Complications<br />
|-<br />
|Patent foramen ovale<br />
|<br />
* Failure of fusion of the septum primum and septum secundum leading to a flap valve opening.<br />
|<br />
* Right-to-left shunt<br />
<br />
* More prominent with increased right atrial pressure.<br />
|<br />
* Majority of patients are asymptomatic<br />
|<br />
* TEE (Gold standard)<br />
<br />
* TTE<br />
<br />
* TCD<br />
|<br />
* Appearance of at least 3 micro-bubbles in the left atrium within three cardiac cycles after the complete opacification of the right atrium<br />
|<br />
|<br />
* Percutaneous closure<br />
* Anticoagulants<br />
* Antiplatelets<br />
|<br />
* Paradoxical embolism<br />
<br />
* Migraine with aura<br />
*Decompression sickness in divers<br />
*Platypnea-orthodeoxia syndrome<br /><br />
|-<br />
|Atrial septal defect<br />
|<br />
* '''Ostium secundum defect''': Failure of the septum secundum to occlude the ostium secundum.<br />
<br />
* '''Ostium primum defect''': Failure of the ostium primum to fuse with the endocardial cushions.<br />
<br />
* '''Superior sinus venosus defect''': The orifice of the superior vena cava overrides the atrial septum above the fossa ovalis.<br />
<br />
* '''Inferior sinus venosus defect''': The orifice of the inferior vena cava overrides the left and right atrium.<br />
*'''Coronary sinus defect''': Absence of a portion of the common wall that separates the coronary sinus and the left atrium.<br />
|<br />
* Continuous left-to-right shunt<br />
|<br />
* Failure to thrive, tachypnea, recurrent respiratory infections, heart failure<br />
<br />
* Commonly asymptomatic during childhood and adolescence<br />
*Adults with large shunts may become symptomatic in the fourth decade presenting with fatigue, exercise intolerance, palpitations, syncope, and shortness of breath.<br />
<br />
*<br />
|<br />
* TTE (Gold standard)<br />
*Cardiac CT<br />
*Cardiac MRI<br />
|<br />
* Hypermobile interatrial septum<br />
* Abrupt septal irregularity<br />
* Right atrial and ventricular volume overload<br />
* Pulmonary artery dilation<br />
*'''Coronary sinus defect''': Enlarged ostium of the coronary sinus and unroofing of the terminal portion of the coronary sinus<br />
|<br />
* Systolic flow murmur in the pulmonary valve region<br />
*Wide, fixed splitting of S2<br />
*Diastolic flow rumble across the tricuspid valve<br />
*Right ventricular heave <br />
|<br />
* Spontaneous closure<br />
*Percutaneous transcatheter closure<br />
*Surgical closure<br />
|<br />
* Right sided heart failure<br />
* Peripheral edema<br />
* Eisenmenger syndrome (cyanosis)<br />
* Paradoxical emboli<br />
* Pulmonary hypertension<br />
|-<br />
|Pulmonary ateriovenous fistula<br />
|<br />
* Abnormal blood vessel(s) connecting the pulmonary arteries and veins directly without interposition of pulmonary capillaries<br />
|<br />
* Right-to-left shunt between the pulmonary artery and pulmonary vein<br />
|<br />
* Symptoms may occur only after the second decade<br />
*Cyanosis<br />
*Hemoptysis<br />
|<br />
* Chest CT<br />
*Pulmonary arteriogram<br />
|<br />
* Appearance of contrast bubbles in the left atrium three to five cardiac cycles after appearance in the right atrium<br />
|<br />
* Clubbing<br />
*Systolic/continuous murmur<br />
|<br />
* Embolization<br />
* Surgical resection<br />
|<br />
* Cerebral ischemia/abscess<br />
*Hemothorax<br />
|}<br />
<br />
==Differential table for aortic stenosis==<br />
<br />
{| class="wikitable"<br />
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;|Diseases<br />
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;|History<br />
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;|Symptoms<br />
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;|Physical Examination<br />
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;|Murmur<br />
! colspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;|Diagnosis<br />
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;|Other Findings<br />
|- style="background: #DCDCDC; padding: 5px; text-align: center;"<br />
!style="background: #4479BA; color: #FFFFFF; text-align: center;|ECG<br />
!style="background: #4479BA; color: #FFFFFF; text-align: center;|CXR<br />
!style="background: #4479BA; color: #FFFFFF; text-align: center;|Echocardiogram<br />
!style="background: #4479BA; color: #FFFFFF; text-align: center;|Cardiac Catheterization<br />
|-<br />
|style="background: #DCDCDC; padding: 5px; text-align: center;" |Aortic stenosis<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Age (aortic valve calcification)<br />
*Syncope<br />
*Orthopnea<br />
*Paroxysmal nocturnal dyspnea<br />
*Acute rheumatic fever<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Chest pain<br />
*Dyspnea on exertion<br />
*Palpitations<br />
*Symptoms of heart failure<br />
| style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Pulsus parvus et tardus<br />
*Pulmonary rales<br />
*Peripheral edema (In CHF patients)<br />
*Jugular venous distension<br />
*Enlarged and laterally displaced point of maximal impulse<br />
<br />
*<br />
| style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Crescendo-decrescendo systolic murmur<br />
*Best heard at the right upper sternal border<br />
*Radiation to the carotid arteries<br />
*Increases with squatting<br />
*Decreases with valsalva maneuver<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Left ventricular hypertrophy''':<br />
<br />
* Wide QRS complex (especially in leads V1-V6)<br />
*ST depression in leads V5-V6<br />
*Left axis deviation<br />
* <br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Enlarged left ventricle<br />
* Enlarged left atrium and pulmonary artery in severe cases<br />
*Calcification of the aortic valve<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Thickening and calcification of the aortic valve<br />
*Left ventricular hypertrophy<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Left heart catheterization:'''<br />
<br />
* Left ventricular and aortic pressures<br />
*The left ventricle generates higher pressures than what is transmitted to the aorta<br />
| style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Associated with von Willibrand disease<br />
|-<br />
| colspan="10" |<br />
|-<br />
|style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Mitral Stenosis]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Age ( Mitral annular calcification in older patients)<br />
<br />
* [[Rheumatic fever]]<br />
<br />
* [[Endocarditis]]<br />
<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* [[Dyspnea on exertion]]<br />
<br />
* [[Paroxysmal nocturnal dyspnea]]<br />
<br />
* [[Orthopnea]]<br />
<br />
* New onset [[atrial fibrillation]]<br />
<br />
| style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Mitral facies<br />
<br />
* Heart murmur<br />
<br />
* [[JVD|Jugular vein distension]]<br />
<br />
* Apical impulse displaced laterally or not palpable <br />
<br />
* Diastolic thrill at the apex <br />
<br />
* Signs of heart failure in severe cases<br />
| style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Diastolic murmur<br />
<br />
* Low pitched<br />
<br />
* Opening snap followed by decrescendo-crescendo rumbling murmur <br />
<br />
* Best heard with the bell of the stethoscope at apex at end-expiration in left lateral decubitus position <br />
<br />
* Intensity increases after a [[valsalva maneuver]], after exercise and after increased after load (eg., squatting, isometric hand grip) <br />
| style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* [[P mitrale]]<br />
* [[Atrial fibrillation]]: No P waves and irregularly irregular rhythm<br />
<br />
* [[Right axis deviation]]<br />
<br />
* Right ventricular hypertropy: Dominant R wave in V1 and V2<br />
| style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Straightening of the left border of the heart suggestive of enlargement of the [[left atrium]]<br />
<br />
* Double right heart border (Enlarged left atrium and normal right atrium) <br />
<br />
* Prominent left atrial appendage<br />
<br />
* Splaying of [[carina|subcarinal angle]] (>120 degrees)<br />
<br />
* Calcification of [[mitral valve]]<br />
<br />
* [[Kerley B lines]] <br />
<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Reduced valve leaflet mobility<br />
<br />
* Valve calcification <br />
<br />
* Doming of mitral valve<br />
<br />
* Valve thickening <br />
* Enlargement of left atrium <br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Right heart catheterization:'''<br />
* [[Pulmonary capillary wedge pressure]] (left atrial pressure) <br />
'''Left heart catheterization:'''<br />
* Pressures in left ventricle<br />
<br />
* Determines the gradient between the left and right atrium during ventricular diastole (marker of the severity of mitral stenosis)<br />
<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* [[Hemoptysis]] ([[heart failure]])<br />
<br />
* [[Ortner's syndrome]]<br />
|-<br />
| colspan="10" |<br />
|-<br />
|style="vertical-align: top;background: #DCDCDC; padding: 5px; text-align: center;" |[[Mitral Regurgitation]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* [[CAD]]<br />
<br />
* [[MI]]<br />
<br />
* [[Rheumatic fever]]<br />
<br />
* [[Endocarditis]]<br />
<br />
* [[Mitral valve prolapse]]<br />
<br />
* [[Cardiomyopathy]]<br />
<br />
* [[Radiation therapy]]<br />
<br />
* Trauma<br />
<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* [[Palpitations]]<br />
<br />
* Symptoms of heart failure in severe cases<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Palpation'''<br />
* Brisk carotid upstroke and hyperdymanic carotid impulse on palpation<br />
<br />
* Apical impulse is displaced to left<br />
<br />
* S3 and a palpable thrill<br />
'''Auscultation'''<br />
* Murmur<br />
<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* [[Holosystolic murmur]]<br />
<br />
* High pitched, blowing<br />
<br />
* Radiates to axilla<br />
<br />
* Best heard with the diaphragm of the stethoscope at apex in left lateral [[decubitus]] position<br />
<br />
* Intensity increases with hand grip or squatting <br />
<br />
* Decrease in intensity on standing or [[valsalva maneuver]] <br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* [[P mitrale]] in lead II<br />
* Increased QRS voltage<br />
* [[Right axis deviation]]<br />
* [[Atrial fibrillation]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Acute MR'''<br />
* [[Kerley B lines]]<br />
* No enlargement of cardiac silhouette<br />
'''Chronic MR'''<br />
* Enlarged cardiac silhouette<br />
* Straightening of left heart border<br />
* Splaying of subcarinal angle<br />
* Calcification of mitral annulus<br />
* Double right heart border<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Enlargement of left atrium and ventricle<br />
* Identify valve abnormality<br />
* Valve calcification<br />
* Severity of regurgitation<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Grading of MR is done with left ventriculography<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Decompensated and acute MR may lead to [[heart failure]]<br />
|-<br />
| colspan="10" |<br />
|-<br />
|style="vertical-align: top;background: #DCDCDC; padding: 5px; text-align: center;" |[[Atrial septal defect]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Frequent respiratory or lung infections<br />
* [[Dyspnea]]<br />
* Tiring when feeding (Infants)<br />
* Shortness of breath on exertion<br />
* [[Palpitations]]<br />
* Swelling of feet<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* [[Shortness of breath]]<br />
* [[Fatigue]]<br />
* [[Failure to thrive]]<br />
* Swelling of feet and abdomen ([[Right heart failure]])<br />
* [[Palpitations]]<br />
* Respiratory infections<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Inspection'''<br />
* Precordial bulge<br />
* Precordial lift<br />
'''Palpation'''<br />
* Right ventricular impulse<br />
* Pulmonary artery pulsations<br />
* Thrill<br />
'''Auscultation'''<br />
* Murmur<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Midsystolic (ejection systolic) murmur<br />
<br />
* Widely split, fixed S2<br />
<br />
* Upper left sternal border<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Normal <br />
* Prolonged PR interval<br />
* [[Right bundle branch block]]<br />
* ECG findings varies according to the underlying type of ASD<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
*Increased pulmonary markings<br />
*[[Cardiomegaly]]<br />
*Triangular appearance of heart<br />
*Schimitar sign<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Gold standard test for diagnosis of atrial septal defect (for more information click [[Atrial septal defect echocardiography]])<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Defect size<br />
* Pulmonary venous return<br />
* [[Pulmonary vascular resistance]]<br />
* [[Pulmonary artery hypertension]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Asymptomatic until later part of their life<br />
* May be associated with [[migraine with aura]]<br />
|-<br />
| colspan="10" |<br />
|-<br />
|style="vertical-align: top;background: #DCDCDC; padding: 5px; text-align: center;" |[[Atrial myxoma|Left Atrial Myxoma]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* [[Dyspnea]]<br />
* [[Orthopnea]]<br />
* [[Pulmonary edema]]<br />
* Hyperpigmentation of skin and endocrine activity<br />
* Cerebral [[embolism]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Symptoms may mimic mitral stenosis<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Skin'''<br />
* Signs of an embolic phenomenon<br />
* [[Raynaud's phenomenon]]<br />
* Swelling<br />
* Clubbing<br />
'''Auscultation:'''<br />
* Lung: Fine crepitations <br />
<br />
* Heart: Characteristic "tumor plop" <br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Early diastolic sound as "tumor plop"<br />
<br />
* Low frequency diastolic murmur may be heard if the tumor obstructing mitral valve <br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Often normal<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Often normal<br />
'''Rare findings:'''<br />
* [[cardiomegaly]]<br />
* Left atrial enlargement<br />
* tumor calcification etc.,<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Initial and most useful diagnostic study<br />
* For more information click [[Myxoma echocardiography or ultrasound]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Useful to detect vascular supply of the tumor by the coronary arteries <br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Associated with Carney complex (genetic predisposition)<br />
|-<br />
| colspan="10" |<br />
|-<br />
|style="vertical-align: top;background: #DCDCDC; padding: 5px; text-align: center;" |Prosthetic Valve Obstruction<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* History of valve replacement<br />
* Systemic embolism<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Shortness of breath<br />
* Fatigue<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Ausculation'''<br />
<br />
Muffling of murmur<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Muffling or disappearance of prosthetic sounds<br />
<br />
* Appearance of new regurgitant or obstructive murmur <br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Degree of stenosis<br />
* Assess thrombus size and location<br />
* Differentiate between thrombus, [[pannus]] and vegetations<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |Causes:<br />
* Thrombus<br />
* Pannus formation<br />
|-<br />
| colspan="10" |<br />
|-<br />
|style="vertical-align: top;background: #DCDCDC; padding: 5px; text-align: center;" |[[Cor Triatriatum]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Dyspnea on exertion <br />
* Recent onset of [[congestive heart failure]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Dsypnea on exertion<br />
* Orthopnea<br />
* Tachypnea<br />
* Palpitations<br />
* Growth failure<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Auscultation'''<br />
* Murmur<br />
'''Other findings'''<br />
* Signs of heart failure<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Diastolic murmur with loud P2<br />
<br />
* No opening snap or a loud S1<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |Non specific but may have<br />
* [[Right axis deviation]]<br />
* Right atrial enlargement<br />
* [[Right ventricular hypertrophy]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Normal cardiac silhouette<br />
* Hemodynamic changes similar to mitral stenosis (non specific findings)<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Direct visualization of membrane through the atrium<br />
* +/- visualization of accessory chamber<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Normal left ventricular hemodynamic profile with a trans atrial gradient<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |Types<br />
* Cor triatriatum sinistrum<br />
* Cor triatriatum dextrum<br />
|-<br />
| colspan="10" |<br />
|-<br />
|style="vertical-align: top;background: #DCDCDC; padding: 5px; text-align: center;" |Congenital Mitral Stenosis<br />
| style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Respiratory distress shortly after birth<br />
* Recurrent severe pulmonary infections<br />
* Other associated congenital cardiovascular anamolies<br />
* [[Atrial fibrillation]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
<br />
'''Infants:'''<br />
* Exhaustion and sweating on feeding<br />
* Rapid breathing<br />
* [[Failure to thrive]]<br />
* Pulmonary infections <br />
* Chronic cough<br />
'''Older patients:'''<br />
* Dyspnea<br />
* Orthopnea<br />
* Paroxysmal nocturnal dyspnea<br />
* Peripheral edema<br />
* Fatigue<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Auscultation'''<br />
* Murmur<br />
'''Other findings'''<br />
* Signs of heart failure<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Mild-Moderate'''<br />
* Loud S1<br />
<br />
* Loud P2<br />
<br />
* Low frequency diastolic murmur best heard at the apex <br />
'''Severe'''<br />
* Soft S1<br />
<br />
* Loud pulmonic component of S2 with minimal respiratory splitting of S2 <br />
<br />
* Holodiastolic murmur with presystolic accentuation best heard at the apex <br />
<br />
* Early diastolic murmur of pulmonic valve regurgitation <br />
<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
*Sharp P waves in leads I and II<br />
*Inversion of P wave in lead III<br />
*Marked Q waves in leads II and III<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Left atrial dilation<br />
* Moderate enlargement of right heart<br />
* Pulmonary venous congestion<br />
* Esophageal compression<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Reduced valve leaflet mobility<br />
* Left atrial size<br />
* Severity of mitral stenosis<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |Very rare condition<br />
|-<br />
| colspan="10" |<br />
|-<br />
|style="vertical-align: top;background: #DCDCDC; padding: 5px; text-align: center;" |Supravalvular Ring Mitral Stenosis<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Other associated congenital heart defects<br />
* Fatigue<br />
* Frequent respiratory infections<br />
* Failure to thrive<br />
* Poor feeding<br />
* Precocious congestive heart failure <br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Shortness of breath<br />
<br />
* Tachypnea<br />
* Dyspnea<br />
* Nocturnal cough<br />
* Heamoptysis<br />
* [[Syncope]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Auscultation:'''<br />
<br />
Lungs: Fine, crepitant rales and rhonchi or wheezes may be present<br />
<br />
Heart: Murmur<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* An apical mid diastolic murmur with presystolic accentuation<br />
<br />
* No opening snap<br />
<br />
* The murmur is more prominent if associated with [[VSD]] or [[PDA]]<br />
<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Left atrial and ventricular enlargement<br />
* Alveolar edema <br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Supramitral ring''':<br />
* Associated with normal mitral valve apparatus<br />
'''Intramitral ring:'''<br />
* Hypomobility of the posterior leaflet<br />
* Reduced interpapillary muscle distance<br />
* Reduced chordal length<br />
* Dominant papillary muscle<br />
* Hypoplastic mitral annulus<br />
(Difficult to visualize membrane <1mm in size)<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Persistently elevated pulmonary venous pressures<br />
* Increased pulmonary artery pressure<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Types'''<br />
* Supramitral<br />
* Intramitral<br />
It is attached between the opening of the atrial appendage and the mitral annulus which helps in differentiating with Cor triatriatum sinister.<br />
* Intramitral type is associated with shone complex<br />
|}</div>
Ifeoma odukwe
https://www.wikidoc.org/index.php?title=Sandbox:_Ifeoma&diff=1608425
Sandbox: Ifeoma
2020-05-16T15:46:14Z
<p>Ifeoma odukwe: /* Physiology */</p>
<hr />
<div>Wikidoc practice session<br />
<br />
==Pathophysiology==<br />
===Physiology===<br />
* Physiology shows you how you work.<br />
:* And how it operates<br />
<br />
# Ifeoma<br />
# Ifrah<br />
# Zaida <br />
# Beenish<br />
<br />
==Classification of dextrocardia==<br />
{| style="border: 0px; font-size: 90%; margin: 3px; width: 1000px"<br />
|valign=top|<br />
|+<br />
! style="background: #4479BA; width: 250px; color: #FFFFFF;"|'''Dextrocardia Types'''<br />
<br />
! style="background: #4479BA; width: 600px; color: #FFFFFF;"|'''Description'''<br />
<br />
|-<br />
<br />
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align=center | '''Dextrocardia with situs solitus '''|| style="padding: 5px 5px; background: #F5F5F5;" |<br />
:* Dextrocardia with normally related great arteries and D-transposition (complete transposition) or L-transposition (congenitally corrected transposition) of the great arteries. Some examples include dextrocardia with D-loop ventricles and normally related great arteries, with L-loop ventricles and L-TGA (congenitally corrected TGA).<br />
:* Embryologic failure of the final leftward shift of the ventricles during development results in dextrocardia with situs solitus, D-loop ventricles, and normally related great arteries.<br />
<br />
|-<br />
<br />
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align=center | '''Dextrocardia with situs inversus '''|| style="padding: 5px 5px; background: #F5F5F5;"|<br />
:* May present with dextrocardia with inversely related great arteries and D-transposition (congenitally corrected transposition) or L-transposition (“uncorrected” transposition) of the great arteries. An example is dextrocardia with D-loop ventricles and D-TGA (congenitally corrected TGA).<br />
<br />
|-<br />
<br />
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align=center | '''Dextrocardia with situs ambiguous (either polyspenia or asplenia)''' || style="padding: 5px 5px; background: #F5F5F5;"|<br />
:* Dextrocardia with any of the above relationships between the ventricles and great vessels.<br />
<br />
|-<br />
<br />
<br />
{|<br />
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"<br />
! rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;|Diseases<br />
| colspan="6" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;|'''Clinical manifestations'''<br />
! colspan="3" rowspan="2" |Para-clinical findings<br />
| colspan="1" rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;|'''Gold standard'''<br />
! rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;|Additional findings<br />
|-<br />
| colspan="3" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;|'''Symptoms'''<br />
! colspan="3" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;|Physical examination<br />
|-<br />
! colspan="3" style="background: #4479BA; color: #FFFFFF; text-align: center;|Imaging<br />
|- <br />
! style="background: #4479BA; color: #FFFFFF; text-align: center;|Exertional dyspnea<br />
! colspan="1" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;|Failure to thrive<br />
! style="background: #4479BA; color: #FFFFFF; text-align: center;|Recurrent respiratory infections<br />
! style="background: #4479BA; color: #FFFFFF; text-align: center;|Murmur on auscultation<br />
! colspan="1" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;|Peripheral edema<br />
! style="background: #4479BA; color: #FFFFFF; text-align: center;|Clubbing<br />
! style="background: #4479BA; color: #FFFFFF; text-align: center;|Echocardiography<br />
! style="background: #4479BA; color: #FFFFFF; text-align: center;|Chest x-ray<br />
! style="background: #4479BA; color: #FFFFFF; text-align: center;|Cardiac CT<br />
|-<br />
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Patent foramen ovale]]<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Appearance of at least 3 micro-bubbles in the left atrium within three cardiac cycles after complete opacification of the right atrium<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | Non specific<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | <br />
* A contrast agent jet from the left atrium to the right atrium toward the inferior vena cava with channel-like appearance of the interatrial septum<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Echocardiogram<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* It is associated with paradoxical embolism, migraine headache, and decompression sickness in divers<br />
|-<br />
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Atrial septal defect]]<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/−<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/−<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/− <br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Systolic flow murmur in the upper left sternal border<br />
* Wide, fixed splitting of S2<br />
* Diastolic flow rumble across the tricuspid valve<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/−<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/−<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Hypermobile interatrial septum<br />
* Abrupt septal irregularity<br />
* Right atrial and ventricular volume overload<br />
* Pulmonary artery dilatation<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Cardiomegaly <br />
* Pulmonary artery enlargement/increased pulmonary vascularity<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Enlargement of the right atrium and ventricle<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Echocardiogram<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Atrial septal defect is classified into 5 types including ostium primum defect, ostium secundum defect, superior sinus venosus defect, inferior sinus venosus defect, and coronary sinus defect<br />
|-<br />
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Ventricular septal defect]]<br />
| style="background: #F5F5F5; padding: 5px;" |-/+<br />
| style="background: #F5F5F5; padding: 5px;" |-/+<br />
| style="background: #F5F5F5; padding: 5px;" |After Eisenmenger syndrome<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Holosystolic murmur<br />
* May mimic aortic stenosis(mid/end dyastolic murmur due to increased pulmonary circulation)<br />
| style="background: #F5F5F5; padding: 5px;" |-/+<br />
| style="background: #F5F5F5; padding: 5px;" |-/+<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Defect localization<br />
*septal dropout in the area adjacent to the tricuspid septal leaflet and below the right border of the aortic annulus<br />
* Direction of jet<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* [[Cardiomegaly]] in large VSD<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Direct visualisation of murmur<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Echocardiogram<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"<br />
!Diseases<br />
!Exertional dyspnea<br />
! colspan="1" rowspan="1" |Failure to thrive<br />
!Recurrent respiratory infections<br />
!Murmur on auscultation<br />
! colspan="1" rowspan="1" |Peripheral edema<br />
!Clubbing<br />
!Echocardiography<br />
!Chest x-ray<br />
!Cardiac CT<br />
|'''Gold standard'''<br />
!Additional findings<br />
|-<br />
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Patent ductus arteriosus]]<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Not at beginning<br />
* May be produced during the course of disease <br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Depends on the size<br />
| style="background: #F5F5F5; padding: 5px;" | -<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Continuous machine-like murmur<br />
| style="background: #F5F5F5; padding: 5px;" |-<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* May be present by progressing<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Golden standard <br />
* In color-Doppler visualization of flow through the patent duct which has a high velocity<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Non-specific<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Used for determining Krichenko classification<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Echocardiogram<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Krichenko criteria for classification is a very important factor for treatment<br />
|-<br />
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Aortic coarctation|Coarctation of the aorta]]<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/−<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/−<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Systolic murmur over the upper sternal border with radiation to the back<br />
*Murmur of mitral regurgitation (holosystolic murmur best heard at the apex)<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Narrowing of the aortic arch at the level of the isthmus<br />
* Left ventricular hypertrophy<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Notching of the posterior fourth to eighth ribs due to dilated intercostal arteries<br />
* Indentation of the aorta at the site of coarctation with pre- and post-stenotic dilation of the aorta (classic "3 sign")<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Dilation of the intercostal arteries<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Echocardiogram<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
*Patients present with arm-leg blood pressure gradient of >20mmHg<br />
|-<br />
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Aortic stenosis]]<br />
| style="background: #F5F5F5; padding: 5px;" |+<br />
| style="background: #F5F5F5; padding: 5px;" |+<br />
| style="background: #F5F5F5; padding: 5px;" |+<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Crescendo-decrescendo mid-systolic (or ejection systolic) murmur<br />
| style="background: #F5F5F5; padding: 5px;" |+/-<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Depending on severity<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Used for finding the location of stenosis<br />
* Finding severity<br />
* Evaluating the flow jet with color-Doppler ultrasound technique<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Non-specific at the beginning<br />
* At progressed stage calcification of the valve and cardiomegally<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
*[[Aortic calcification|Calcification score]]<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* MRI<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* MRI provides a more detailed structural and dynamic assessment of the aortic valve and left ventricle, in particular<br />
|-<br />
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Pulmonary valve stenosis|Pulmonary stenosis]]<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Depending on severity<br />
| style="background: #F5F5F5; padding: 5px;" | -<br />
| style="background: #F5F5F5; padding: 5px;" | -/+<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Continuous systolic murmur<br />
| style="background: #F5F5F5; padding: 5px;" |-<br />
| style="background: #F5F5F5; padding: 5px;" | -/+<br />
| style="background: #F5F5F5; padding: 5px;" | <br />
* Right atrial hypertrophy<br />
| style="background: #F5F5F5; padding: 5px;" | <br />
* Non-specific<br />
| style="background: #F5F5F5; padding: 5px;" | <br />
* Direct visualization of stenosis<br />
| style="background: #F5F5F5; padding: 5px;" | <br />
* Echocardiogram<br />
| style="background: #F5F5F5; padding: 5px;" | <br />
|}<br />
<br />
<br />
<br />
<br />
<br />
<br />
<br />
<br />
<br />
<br />
<br />
{| class="wikitable"<br />
|+<br />
!Diseases<br />
!Pathophysiology<br />
!Shunt<br />
!Symptoms<br />
!Diagnosis<br />
!Echocardiography findings<br />
!Physical examination<br />
!Treatment<br />
!Complications<br />
|-<br />
|Patent foramen ovale<br />
|<br />
* Failure of fusion of the septum primum and septum secundum leading to a flap valve opening.<br />
|<br />
* Right-to-left shunt<br />
<br />
* More prominent with increased right atrial pressure.<br />
|<br />
* Majority of patients are asymptomatic<br />
|<br />
* TEE (Gold standard)<br />
<br />
* TTE<br />
<br />
* TCD<br />
|<br />
* Appearance of at least 3 micro-bubbles in the left atrium within three cardiac cycles after the complete opacification of the right atrium<br />
|<br />
|<br />
* Percutaneous closure<br />
* Anticoagulants<br />
* Antiplatelets<br />
|<br />
* Paradoxical embolism<br />
<br />
* Migraine with aura<br />
*Decompression sickness in divers<br />
*Platypnea-orthodeoxia syndrome<br /><br />
|-<br />
|Atrial septal defect<br />
|<br />
* '''Ostium secundum defect''': Failure of the septum secundum to occlude the ostium secundum.<br />
<br />
* '''Ostium primum defect''': Failure of the ostium primum to fuse with the endocardial cushions.<br />
<br />
* '''Superior sinus venosus defect''': The orifice of the superior vena cava overrides the atrial septum above the fossa ovalis.<br />
<br />
* '''Inferior sinus venosus defect''': The orifice of the inferior vena cava overrides the left and right atrium.<br />
*'''Coronary sinus defect''': Absence of a portion of the common wall that separates the coronary sinus and the left atrium.<br />
|<br />
* Continuous left-to-right shunt<br />
|<br />
* Failure to thrive, tachypnea, recurrent respiratory infections, heart failure<br />
<br />
* Commonly asymptomatic during childhood and adolescence<br />
*Adults with large shunts may become symptomatic in the fourth decade presenting with fatigue, exercise intolerance, palpitations, syncope, and shortness of breath.<br />
<br />
*<br />
|<br />
* TTE (Gold standard)<br />
*Cardiac CT<br />
*Cardiac MRI<br />
|<br />
* Hypermobile interatrial septum<br />
* Abrupt septal irregularity<br />
* Right atrial and ventricular volume overload<br />
* Pulmonary artery dilation<br />
*'''Coronary sinus defect''': Enlarged ostium of the coronary sinus and unroofing of the terminal portion of the coronary sinus<br />
|<br />
* Systolic flow murmur in the pulmonary valve region<br />
*Wide, fixed splitting of S2<br />
*Diastolic flow rumble across the tricuspid valve<br />
*Right ventricular heave <br />
|<br />
* Spontaneous closure<br />
*Percutaneous transcatheter closure<br />
*Surgical closure<br />
|<br />
* Right sided heart failure<br />
* Peripheral edema<br />
* Eisenmenger syndrome (cyanosis)<br />
* Paradoxical emboli<br />
* Pulmonary hypertension<br />
|-<br />
|Pulmonary ateriovenous fistula<br />
|<br />
* Abnormal blood vessel(s) connecting the pulmonary arteries and veins directly without interposition of pulmonary capillaries<br />
|<br />
* Right-to-left shunt between the pulmonary artery and pulmonary vein<br />
|<br />
* Symptoms may occur only after the second decade<br />
*Cyanosis<br />
*Hemoptysis<br />
|<br />
* Chest CT<br />
*Pulmonary arteriogram<br />
|<br />
* Appearance of contrast bubbles in the left atrium three to five cardiac cycles after appearance in the right atrium<br />
|<br />
* Clubbing<br />
*Systolic/continuous murmur<br />
|<br />
* Embolization<br />
* Surgical resection<br />
|<br />
* Cerebral ischemia/abscess<br />
*Hemothorax<br />
|}<br />
<br />
==Differential table for aortic stenosis==<br />
<br />
{| class="wikitable"<br />
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;|Diseases<br />
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;|History<br />
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;|Symptoms<br />
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;|Physical Examination<br />
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;|Murmur<br />
! colspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;|Diagnosis<br />
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;|Other Findings<br />
|- style="background: #DCDCDC; padding: 5px; text-align: center;"<br />
!style="background: #4479BA; color: #FFFFFF; text-align: center;|ECG<br />
!style="background: #4479BA; color: #FFFFFF; text-align: center;|CXR<br />
!style="background: #4479BA; color: #FFFFFF; text-align: center;|Echocardiogram<br />
!style="background: #4479BA; color: #FFFFFF; text-align: center;|Cardiac Catheterization<br />
|-<br />
|style="background: #DCDCDC; padding: 5px; text-align: center;" |Aortic stenosis<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Age (aortic valve calcification)<br />
*Syncope<br />
*Orthopnea<br />
*Paroxysmal nocturnal dyspnea<br />
*Acute rheumatic fever<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Chest pain<br />
*Dyspnea on exertion<br />
*Palpitations<br />
*Symptoms of heart failure<br />
| style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Pulsus parvus et tardus<br />
*Pulmonary rales<br />
*Peripheral edema (In CHF patients)<br />
*Jugular venous distension<br />
*Enlarged and laterally displaced point of maximal impulse<br />
<br />
*<br />
| style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Crescendo-decrescendo systolic murmur<br />
*Best heard at the right upper sternal border<br />
*Radiation to the carotid arteries<br />
*Increases with squatting<br />
*Decreases with valsalva maneuver<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Left ventricular hypertrophy''':<br />
<br />
* Wide QRS complex (especially in leads V1-V6)<br />
*ST depression in leads V5-V6<br />
*Left axis deviation<br />
* <br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Enlarged left ventricle<br />
* Enlarged left atrium and pulmonary artery in severe cases<br />
*Calcification of the aortic valve<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Thickening and calcification of the aortic valve<br />
*Left ventricular hypertrophy<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Left heart catheterization:'''<br />
<br />
* Left ventricular and aortic pressures<br />
*The left ventricle generates higher pressures than what is transmitted to the aorta<br />
| style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Associated with von Willibrand disease<br />
|-<br />
| colspan="10" |<br />
|-<br />
|style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Mitral Stenosis]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Age ( Mitral annular calcification in older patients)<br />
<br />
* [[Rheumatic fever]]<br />
<br />
* [[Endocarditis]]<br />
<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* [[Dyspnea on exertion]]<br />
<br />
* [[Paroxysmal nocturnal dyspnea]]<br />
<br />
* [[Orthopnea]]<br />
<br />
* New onset [[atrial fibrillation]]<br />
<br />
| style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Mitral facies<br />
<br />
* Heart murmur<br />
<br />
* [[JVD|Jugular vein distension]]<br />
<br />
* Apical impulse displaced laterally or not palpable <br />
<br />
* Diastolic thrill at the apex <br />
<br />
* Signs of heart failure in severe cases<br />
| style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Diastolic murmur<br />
<br />
* Low pitched<br />
<br />
* Opening snap followed by decrescendo-crescendo rumbling murmur <br />
<br />
* Best heard with the bell of the stethoscope at apex at end-expiration in left lateral decubitus position <br />
<br />
* Intensity increases after a [[valsalva maneuver]], after exercise and after increased after load (eg., squatting, isometric hand grip) <br />
| style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* [[P mitrale]]<br />
* [[Atrial fibrillation]]: No P waves and irregularly irregular rhythm<br />
<br />
* [[Right axis deviation]]<br />
<br />
* Right ventricular hypertropy: Dominant R wave in V1 and V2<br />
| style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Straightening of the left border of the heart suggestive of enlargement of the [[left atrium]]<br />
<br />
* Double right heart border (Enlarged left atrium and normal right atrium) <br />
<br />
* Prominent left atrial appendage<br />
<br />
* Splaying of [[carina|subcarinal angle]] (>120 degrees)<br />
<br />
* Calcification of [[mitral valve]]<br />
<br />
* [[Kerley B lines]] <br />
<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Reduced valve leaflet mobility<br />
<br />
* Valve calcification <br />
<br />
* Doming of mitral valve<br />
<br />
* Valve thickening <br />
* Enlargement of left atrium <br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Right heart catheterization:'''<br />
* [[Pulmonary capillary wedge pressure]] (left atrial pressure) <br />
'''Left heart catheterization:'''<br />
* Pressures in left ventricle<br />
<br />
* Determines the gradient between the left and right atrium during ventricular diastole (marker of the severity of mitral stenosis)<br />
<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* [[Hemoptysis]] ([[heart failure]])<br />
<br />
* [[Ortner's syndrome]]<br />
|-<br />
| colspan="10" |<br />
|-<br />
|style="vertical-align: top;background: #DCDCDC; padding: 5px; text-align: center;" |[[Mitral Regurgitation]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* [[CAD]]<br />
<br />
* [[MI]]<br />
<br />
* [[Rheumatic fever]]<br />
<br />
* [[Endocarditis]]<br />
<br />
* [[Mitral valve prolapse]]<br />
<br />
* [[Cardiomyopathy]]<br />
<br />
* [[Radiation therapy]]<br />
<br />
* Trauma<br />
<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* [[Palpitations]]<br />
<br />
* Symptoms of heart failure in severe cases<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Palpation'''<br />
* Brisk carotid upstroke and hyperdymanic carotid impulse on palpation<br />
<br />
* Apical impulse is displaced to left<br />
<br />
* S3 and a palpable thrill<br />
'''Auscultation'''<br />
* Murmur<br />
<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* [[Holosystolic murmur]]<br />
<br />
* High pitched, blowing<br />
<br />
* Radiates to axilla<br />
<br />
* Best heard with the diaphragm of the stethoscope at apex in left lateral [[decubitus]] position<br />
<br />
* Intensity increases with hand grip or squatting <br />
<br />
* Decrease in intensity on standing or [[valsalva maneuver]] <br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* [[P mitrale]] in lead II<br />
* Increased QRS voltage<br />
* [[Right axis deviation]]<br />
* [[Atrial fibrillation]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Acute MR'''<br />
* [[Kerley B lines]]<br />
* No enlargement of cardiac silhouette<br />
'''Chronic MR'''<br />
* Enlarged cardiac silhouette<br />
* Straightening of left heart border<br />
* Splaying of subcarinal angle<br />
* Calcification of mitral annulus<br />
* Double right heart border<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Enlargement of left atrium and ventricle<br />
* Identify valve abnormality<br />
* Valve calcification<br />
* Severity of regurgitation<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Grading of MR is done with left ventriculography<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Decompensated and acute MR may lead to [[heart failure]]<br />
|-<br />
| colspan="10" |<br />
|-<br />
|style="vertical-align: top;background: #DCDCDC; padding: 5px; text-align: center;" |[[Atrial septal defect]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Frequent respiratory or lung infections<br />
* [[Dyspnea]]<br />
* Tiring when feeding (Infants)<br />
* Shortness of breath on exertion<br />
* [[Palpitations]]<br />
* Swelling of feet<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* [[Shortness of breath]]<br />
* [[Fatigue]]<br />
* [[Failure to thrive]]<br />
* Swelling of feet and abdomen ([[Right heart failure]])<br />
* [[Palpitations]]<br />
* Respiratory infections<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Inspection'''<br />
* Precordial bulge<br />
* Precordial lift<br />
'''Palpation'''<br />
* Right ventricular impulse<br />
* Pulmonary artery pulsations<br />
* Thrill<br />
'''Auscultation'''<br />
* Murmur<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Midsystolic (ejection systolic) murmur<br />
<br />
* Widely split, fixed S2<br />
<br />
* Upper left sternal border<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Normal <br />
* Prolonged PR interval<br />
* [[Right bundle branch block]]<br />
* ECG findings varies according to the underlying type of ASD<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
*Increased pulmonary markings<br />
*[[Cardiomegaly]]<br />
*Triangular appearance of heart<br />
*Schimitar sign<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Gold standard test for diagnosis of atrial septal defect (for more information click [[Atrial septal defect echocardiography]])<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Defect size<br />
* Pulmonary venous return<br />
* [[Pulmonary vascular resistance]]<br />
* [[Pulmonary artery hypertension]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Asymptomatic until later part of their life<br />
* May be associated with [[migraine with aura]]<br />
|-<br />
| colspan="10" |<br />
|-<br />
|style="vertical-align: top;background: #DCDCDC; padding: 5px; text-align: center;" |[[Atrial myxoma|Left Atrial Myxoma]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* [[Dyspnea]]<br />
* [[Orthopnea]]<br />
* [[Pulmonary edema]]<br />
* Hyperpigmentation of skin and endocrine activity<br />
* Cerebral [[embolism]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Symptoms may mimic mitral stenosis<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Skin'''<br />
* Signs of an embolic phenomenon<br />
* [[Raynaud's phenomenon]]<br />
* Swelling<br />
* Clubbing<br />
'''Auscultation:'''<br />
* Lung: Fine crepitations <br />
<br />
* Heart: Characteristic "tumor plop" <br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Early diastolic sound as "tumor plop"<br />
<br />
* Low frequency diastolic murmur may be heard if the tumor obstructing mitral valve <br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Often normal<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Often normal<br />
'''Rare findings:'''<br />
* [[cardiomegaly]]<br />
* Left atrial enlargement<br />
* tumor calcification etc.,<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Initial and most useful diagnostic study<br />
* For more information click [[Myxoma echocardiography or ultrasound]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Useful to detect vascular supply of the tumor by the coronary arteries <br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Associated with Carney complex (genetic predisposition)<br />
|-<br />
| colspan="10" |<br />
|-<br />
|style="vertical-align: top;background: #DCDCDC; padding: 5px; text-align: center;" |Prosthetic Valve Obstruction<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* History of valve replacement<br />
* Systemic embolism<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Shortness of breath<br />
* Fatigue<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Ausculation'''<br />
<br />
Muffling of murmur<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Muffling or disappearance of prosthetic sounds<br />
<br />
* Appearance of new regurgitant or obstructive murmur <br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Degree of stenosis<br />
* Assess thrombus size and location<br />
* Differentiate between thrombus, [[pannus]] and vegetations<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |Causes:<br />
* Thrombus<br />
* Pannus formation<br />
|-<br />
| colspan="10" |<br />
|-<br />
|style="vertical-align: top;background: #DCDCDC; padding: 5px; text-align: center;" |[[Cor Triatriatum]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Dyspnea on exertion <br />
* Recent onset of [[congestive heart failure]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Dsypnea on exertion<br />
* Orthopnea<br />
* Tachypnea<br />
* Palpitations<br />
* Growth failure<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Auscultation'''<br />
* Murmur<br />
'''Other findings'''<br />
* Signs of heart failure<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Diastolic murmur with loud P2<br />
<br />
* No opening snap or a loud S1<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |Non specific but may have<br />
* [[Right axis deviation]]<br />
* Right atrial enlargement<br />
* [[Right ventricular hypertrophy]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Normal cardiac silhouette<br />
* Hemodynamic changes similar to mitral stenosis (non specific findings)<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Direct visualization of membrane through the atrium<br />
* +/- visualization of accessory chamber<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Normal left ventricular hemodynamic profile with a trans atrial gradient<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |Types<br />
* Cor triatriatum sinistrum<br />
* Cor triatriatum dextrum<br />
|-<br />
| colspan="10" |<br />
|-<br />
|style="vertical-align: top;background: #DCDCDC; padding: 5px; text-align: center;" |Congenital Mitral Stenosis<br />
| style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Respiratory distress shortly after birth<br />
* Recurrent severe pulmonary infections<br />
* Other associated congenital cardiovascular anamolies<br />
* [[Atrial fibrillation]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
<br />
'''Infants:'''<br />
* Exhaustion and sweating on feeding<br />
* Rapid breathing<br />
* [[Failure to thrive]]<br />
* Pulmonary infections <br />
* Chronic cough<br />
'''Older patients:'''<br />
* Dyspnea<br />
* Orthopnea<br />
* Paroxysmal nocturnal dyspnea<br />
* Peripheral edema<br />
* Fatigue<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Auscultation'''<br />
* Murmur<br />
'''Other findings'''<br />
* Signs of heart failure<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Mild-Moderate'''<br />
* Loud S1<br />
<br />
* Loud P2<br />
<br />
* Low frequency diastolic murmur best heard at the apex <br />
'''Severe'''<br />
* Soft S1<br />
<br />
* Loud pulmonic component of S2 with minimal respiratory splitting of S2 <br />
<br />
* Holodiastolic murmur with presystolic accentuation best heard at the apex <br />
<br />
* Early diastolic murmur of pulmonic valve regurgitation <br />
<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
*Sharp P waves in leads I and II<br />
*Inversion of P wave in lead III<br />
*Marked Q waves in leads II and III<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Left atrial dilation<br />
* Moderate enlargement of right heart<br />
* Pulmonary venous congestion<br />
* Esophageal compression<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Reduced valve leaflet mobility<br />
* Left atrial size<br />
* Severity of mitral stenosis<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |Very rare condition<br />
|-<br />
| colspan="10" |<br />
|-<br />
|style="vertical-align: top;background: #DCDCDC; padding: 5px; text-align: center;" |Supravalvular Ring Mitral Stenosis<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Other associated congenital heart defects<br />
* Fatigue<br />
* Frequent respiratory infections<br />
* Failure to thrive<br />
* Poor feeding<br />
* Precocious congestive heart failure <br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Shortness of breath<br />
<br />
* Tachypnea<br />
* Dyspnea<br />
* Nocturnal cough<br />
* Heamoptysis<br />
* [[Syncope]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Auscultation:'''<br />
<br />
Lungs: Fine, crepitant rales and rhonchi or wheezes may be present<br />
<br />
Heart: Murmur<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* An apical mid diastolic murmur with presystolic accentuation<br />
<br />
* No opening snap<br />
<br />
* The murmur is more prominent if associated with [[VSD]] or [[PDA]]<br />
<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Left atrial and ventricular enlargement<br />
* Alveolar edema <br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Supramitral ring''':<br />
* Associated with normal mitral valve apparatus<br />
'''Intramitral ring:'''<br />
* Hypomobility of the posterior leaflet<br />
* Reduced interpapillary muscle distance<br />
* Reduced chordal length<br />
* Dominant papillary muscle<br />
* Hypoplastic mitral annulus<br />
(Difficult to visualize membrane <1mm in size)<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Persistently elevated pulmonary venous pressures<br />
* Increased pulmonary artery pressure<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Types'''<br />
* Supramitral<br />
* Intramitral<br />
It is attached between the opening of the atrial appendage and the mitral annulus which helps in differentiating with Cor triatriatum sinister.<br />
* Intramitral type is associated with shone complex<br />
|}</div>
Ifeoma odukwe
https://www.wikidoc.org/index.php?title=Sandbox:_Ifeoma&diff=1608424
Sandbox: Ifeoma
2020-05-16T15:41:04Z
<p>Ifeoma odukwe: /* Physiology */</p>
<hr />
<div>Wikidoc practice session<br />
<br />
==Pathophysiology==<br />
===Physiology===<br />
* Physiology shows you how you work.<br />
:* And how it operates<br />
<br />
==Classification of dextrocardia==<br />
{| style="border: 0px; font-size: 90%; margin: 3px; width: 1000px"<br />
|valign=top|<br />
|+<br />
! style="background: #4479BA; width: 250px; color: #FFFFFF;"|'''Dextrocardia Types'''<br />
<br />
! style="background: #4479BA; width: 600px; color: #FFFFFF;"|'''Description'''<br />
<br />
|-<br />
<br />
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align=center | '''Dextrocardia with situs solitus '''|| style="padding: 5px 5px; background: #F5F5F5;" |<br />
:* Dextrocardia with normally related great arteries and D-transposition (complete transposition) or L-transposition (congenitally corrected transposition) of the great arteries. Some examples include dextrocardia with D-loop ventricles and normally related great arteries, with L-loop ventricles and L-TGA (congenitally corrected TGA).<br />
:* Embryologic failure of the final leftward shift of the ventricles during development results in dextrocardia with situs solitus, D-loop ventricles, and normally related great arteries.<br />
<br />
|-<br />
<br />
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align=center | '''Dextrocardia with situs inversus '''|| style="padding: 5px 5px; background: #F5F5F5;"|<br />
:* May present with dextrocardia with inversely related great arteries and D-transposition (congenitally corrected transposition) or L-transposition (“uncorrected” transposition) of the great arteries. An example is dextrocardia with D-loop ventricles and D-TGA (congenitally corrected TGA).<br />
<br />
|-<br />
<br />
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align=center | '''Dextrocardia with situs ambiguous (either polyspenia or asplenia)''' || style="padding: 5px 5px; background: #F5F5F5;"|<br />
:* Dextrocardia with any of the above relationships between the ventricles and great vessels.<br />
<br />
|-<br />
<br />
<br />
{|<br />
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"<br />
! rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;|Diseases<br />
| colspan="6" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;|'''Clinical manifestations'''<br />
! colspan="3" rowspan="2" |Para-clinical findings<br />
| colspan="1" rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;|'''Gold standard'''<br />
! rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;|Additional findings<br />
|-<br />
| colspan="3" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;|'''Symptoms'''<br />
! colspan="3" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;|Physical examination<br />
|-<br />
! colspan="3" style="background: #4479BA; color: #FFFFFF; text-align: center;|Imaging<br />
|- <br />
! style="background: #4479BA; color: #FFFFFF; text-align: center;|Exertional dyspnea<br />
! colspan="1" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;|Failure to thrive<br />
! style="background: #4479BA; color: #FFFFFF; text-align: center;|Recurrent respiratory infections<br />
! style="background: #4479BA; color: #FFFFFF; text-align: center;|Murmur on auscultation<br />
! colspan="1" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;|Peripheral edema<br />
! style="background: #4479BA; color: #FFFFFF; text-align: center;|Clubbing<br />
! style="background: #4479BA; color: #FFFFFF; text-align: center;|Echocardiography<br />
! style="background: #4479BA; color: #FFFFFF; text-align: center;|Chest x-ray<br />
! style="background: #4479BA; color: #FFFFFF; text-align: center;|Cardiac CT<br />
|-<br />
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Patent foramen ovale]]<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Appearance of at least 3 micro-bubbles in the left atrium within three cardiac cycles after complete opacification of the right atrium<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | Non specific<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | <br />
* A contrast agent jet from the left atrium to the right atrium toward the inferior vena cava with channel-like appearance of the interatrial septum<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Echocardiogram<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* It is associated with paradoxical embolism, migraine headache, and decompression sickness in divers<br />
|-<br />
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Atrial septal defect]]<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/−<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/−<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/− <br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Systolic flow murmur in the upper left sternal border<br />
* Wide, fixed splitting of S2<br />
* Diastolic flow rumble across the tricuspid valve<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/−<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/−<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Hypermobile interatrial septum<br />
* Abrupt septal irregularity<br />
* Right atrial and ventricular volume overload<br />
* Pulmonary artery dilatation<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Cardiomegaly <br />
* Pulmonary artery enlargement/increased pulmonary vascularity<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Enlargement of the right atrium and ventricle<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Echocardiogram<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Atrial septal defect is classified into 5 types including ostium primum defect, ostium secundum defect, superior sinus venosus defect, inferior sinus venosus defect, and coronary sinus defect<br />
|-<br />
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Ventricular septal defect]]<br />
| style="background: #F5F5F5; padding: 5px;" |-/+<br />
| style="background: #F5F5F5; padding: 5px;" |-/+<br />
| style="background: #F5F5F5; padding: 5px;" |After Eisenmenger syndrome<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Holosystolic murmur<br />
* May mimic aortic stenosis(mid/end dyastolic murmur due to increased pulmonary circulation)<br />
| style="background: #F5F5F5; padding: 5px;" |-/+<br />
| style="background: #F5F5F5; padding: 5px;" |-/+<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Defect localization<br />
*septal dropout in the area adjacent to the tricuspid septal leaflet and below the right border of the aortic annulus<br />
* Direction of jet<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* [[Cardiomegaly]] in large VSD<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Direct visualisation of murmur<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Echocardiogram<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"<br />
!Diseases<br />
!Exertional dyspnea<br />
! colspan="1" rowspan="1" |Failure to thrive<br />
!Recurrent respiratory infections<br />
!Murmur on auscultation<br />
! colspan="1" rowspan="1" |Peripheral edema<br />
!Clubbing<br />
!Echocardiography<br />
!Chest x-ray<br />
!Cardiac CT<br />
|'''Gold standard'''<br />
!Additional findings<br />
|-<br />
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Patent ductus arteriosus]]<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Not at beginning<br />
* May be produced during the course of disease <br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Depends on the size<br />
| style="background: #F5F5F5; padding: 5px;" | -<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Continuous machine-like murmur<br />
| style="background: #F5F5F5; padding: 5px;" |-<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* May be present by progressing<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Golden standard <br />
* In color-Doppler visualization of flow through the patent duct which has a high velocity<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Non-specific<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Used for determining Krichenko classification<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Echocardiogram<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Krichenko criteria for classification is a very important factor for treatment<br />
|-<br />
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Aortic coarctation|Coarctation of the aorta]]<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/−<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/−<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Systolic murmur over the upper sternal border with radiation to the back<br />
*Murmur of mitral regurgitation (holosystolic murmur best heard at the apex)<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Narrowing of the aortic arch at the level of the isthmus<br />
* Left ventricular hypertrophy<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Notching of the posterior fourth to eighth ribs due to dilated intercostal arteries<br />
* Indentation of the aorta at the site of coarctation with pre- and post-stenotic dilation of the aorta (classic "3 sign")<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Dilation of the intercostal arteries<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Echocardiogram<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
*Patients present with arm-leg blood pressure gradient of >20mmHg<br />
|-<br />
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Aortic stenosis]]<br />
| style="background: #F5F5F5; padding: 5px;" |+<br />
| style="background: #F5F5F5; padding: 5px;" |+<br />
| style="background: #F5F5F5; padding: 5px;" |+<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Crescendo-decrescendo mid-systolic (or ejection systolic) murmur<br />
| style="background: #F5F5F5; padding: 5px;" |+/-<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Depending on severity<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Used for finding the location of stenosis<br />
* Finding severity<br />
* Evaluating the flow jet with color-Doppler ultrasound technique<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Non-specific at the beginning<br />
* At progressed stage calcification of the valve and cardiomegally<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
*[[Aortic calcification|Calcification score]]<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* MRI<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* MRI provides a more detailed structural and dynamic assessment of the aortic valve and left ventricle, in particular<br />
|-<br />
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Pulmonary valve stenosis|Pulmonary stenosis]]<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Depending on severity<br />
| style="background: #F5F5F5; padding: 5px;" | -<br />
| style="background: #F5F5F5; padding: 5px;" | -/+<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Continuous systolic murmur<br />
| style="background: #F5F5F5; padding: 5px;" |-<br />
| style="background: #F5F5F5; padding: 5px;" | -/+<br />
| style="background: #F5F5F5; padding: 5px;" | <br />
* Right atrial hypertrophy<br />
| style="background: #F5F5F5; padding: 5px;" | <br />
* Non-specific<br />
| style="background: #F5F5F5; padding: 5px;" | <br />
* Direct visualization of stenosis<br />
| style="background: #F5F5F5; padding: 5px;" | <br />
* Echocardiogram<br />
| style="background: #F5F5F5; padding: 5px;" | <br />
|}<br />
<br />
<br />
<br />
<br />
<br />
<br />
<br />
<br />
<br />
<br />
<br />
{| class="wikitable"<br />
|+<br />
!Diseases<br />
!Pathophysiology<br />
!Shunt<br />
!Symptoms<br />
!Diagnosis<br />
!Echocardiography findings<br />
!Physical examination<br />
!Treatment<br />
!Complications<br />
|-<br />
|Patent foramen ovale<br />
|<br />
* Failure of fusion of the septum primum and septum secundum leading to a flap valve opening.<br />
|<br />
* Right-to-left shunt<br />
<br />
* More prominent with increased right atrial pressure.<br />
|<br />
* Majority of patients are asymptomatic<br />
|<br />
* TEE (Gold standard)<br />
<br />
* TTE<br />
<br />
* TCD<br />
|<br />
* Appearance of at least 3 micro-bubbles in the left atrium within three cardiac cycles after the complete opacification of the right atrium<br />
|<br />
|<br />
* Percutaneous closure<br />
* Anticoagulants<br />
* Antiplatelets<br />
|<br />
* Paradoxical embolism<br />
<br />
* Migraine with aura<br />
*Decompression sickness in divers<br />
*Platypnea-orthodeoxia syndrome<br /><br />
|-<br />
|Atrial septal defect<br />
|<br />
* '''Ostium secundum defect''': Failure of the septum secundum to occlude the ostium secundum.<br />
<br />
* '''Ostium primum defect''': Failure of the ostium primum to fuse with the endocardial cushions.<br />
<br />
* '''Superior sinus venosus defect''': The orifice of the superior vena cava overrides the atrial septum above the fossa ovalis.<br />
<br />
* '''Inferior sinus venosus defect''': The orifice of the inferior vena cava overrides the left and right atrium.<br />
*'''Coronary sinus defect''': Absence of a portion of the common wall that separates the coronary sinus and the left atrium.<br />
|<br />
* Continuous left-to-right shunt<br />
|<br />
* Failure to thrive, tachypnea, recurrent respiratory infections, heart failure<br />
<br />
* Commonly asymptomatic during childhood and adolescence<br />
*Adults with large shunts may become symptomatic in the fourth decade presenting with fatigue, exercise intolerance, palpitations, syncope, and shortness of breath.<br />
<br />
*<br />
|<br />
* TTE (Gold standard)<br />
*Cardiac CT<br />
*Cardiac MRI<br />
|<br />
* Hypermobile interatrial septum<br />
* Abrupt septal irregularity<br />
* Right atrial and ventricular volume overload<br />
* Pulmonary artery dilation<br />
*'''Coronary sinus defect''': Enlarged ostium of the coronary sinus and unroofing of the terminal portion of the coronary sinus<br />
|<br />
* Systolic flow murmur in the pulmonary valve region<br />
*Wide, fixed splitting of S2<br />
*Diastolic flow rumble across the tricuspid valve<br />
*Right ventricular heave <br />
|<br />
* Spontaneous closure<br />
*Percutaneous transcatheter closure<br />
*Surgical closure<br />
|<br />
* Right sided heart failure<br />
* Peripheral edema<br />
* Eisenmenger syndrome (cyanosis)<br />
* Paradoxical emboli<br />
* Pulmonary hypertension<br />
|-<br />
|Pulmonary ateriovenous fistula<br />
|<br />
* Abnormal blood vessel(s) connecting the pulmonary arteries and veins directly without interposition of pulmonary capillaries<br />
|<br />
* Right-to-left shunt between the pulmonary artery and pulmonary vein<br />
|<br />
* Symptoms may occur only after the second decade<br />
*Cyanosis<br />
*Hemoptysis<br />
|<br />
* Chest CT<br />
*Pulmonary arteriogram<br />
|<br />
* Appearance of contrast bubbles in the left atrium three to five cardiac cycles after appearance in the right atrium<br />
|<br />
* Clubbing<br />
*Systolic/continuous murmur<br />
|<br />
* Embolization<br />
* Surgical resection<br />
|<br />
* Cerebral ischemia/abscess<br />
*Hemothorax<br />
|}<br />
<br />
==Differential table for aortic stenosis==<br />
<br />
{| class="wikitable"<br />
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;|Diseases<br />
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;|History<br />
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;|Symptoms<br />
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;|Physical Examination<br />
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;|Murmur<br />
! colspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;|Diagnosis<br />
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;|Other Findings<br />
|- style="background: #DCDCDC; padding: 5px; text-align: center;"<br />
!style="background: #4479BA; color: #FFFFFF; text-align: center;|ECG<br />
!style="background: #4479BA; color: #FFFFFF; text-align: center;|CXR<br />
!style="background: #4479BA; color: #FFFFFF; text-align: center;|Echocardiogram<br />
!style="background: #4479BA; color: #FFFFFF; text-align: center;|Cardiac Catheterization<br />
|-<br />
|style="background: #DCDCDC; padding: 5px; text-align: center;" |Aortic stenosis<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Age (aortic valve calcification)<br />
*Syncope<br />
*Orthopnea<br />
*Paroxysmal nocturnal dyspnea<br />
*Acute rheumatic fever<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Chest pain<br />
*Dyspnea on exertion<br />
*Palpitations<br />
*Symptoms of heart failure<br />
| style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Pulsus parvus et tardus<br />
*Pulmonary rales<br />
*Peripheral edema (In CHF patients)<br />
*Jugular venous distension<br />
*Enlarged and laterally displaced point of maximal impulse<br />
<br />
*<br />
| style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Crescendo-decrescendo systolic murmur<br />
*Best heard at the right upper sternal border<br />
*Radiation to the carotid arteries<br />
*Increases with squatting<br />
*Decreases with valsalva maneuver<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Left ventricular hypertrophy''':<br />
<br />
* Wide QRS complex (especially in leads V1-V6)<br />
*ST depression in leads V5-V6<br />
*Left axis deviation<br />
* <br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Enlarged left ventricle<br />
* Enlarged left atrium and pulmonary artery in severe cases<br />
*Calcification of the aortic valve<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Thickening and calcification of the aortic valve<br />
*Left ventricular hypertrophy<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Left heart catheterization:'''<br />
<br />
* Left ventricular and aortic pressures<br />
*The left ventricle generates higher pressures than what is transmitted to the aorta<br />
| style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Associated with von Willibrand disease<br />
|-<br />
| colspan="10" |<br />
|-<br />
|style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Mitral Stenosis]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Age ( Mitral annular calcification in older patients)<br />
<br />
* [[Rheumatic fever]]<br />
<br />
* [[Endocarditis]]<br />
<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* [[Dyspnea on exertion]]<br />
<br />
* [[Paroxysmal nocturnal dyspnea]]<br />
<br />
* [[Orthopnea]]<br />
<br />
* New onset [[atrial fibrillation]]<br />
<br />
| style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Mitral facies<br />
<br />
* Heart murmur<br />
<br />
* [[JVD|Jugular vein distension]]<br />
<br />
* Apical impulse displaced laterally or not palpable <br />
<br />
* Diastolic thrill at the apex <br />
<br />
* Signs of heart failure in severe cases<br />
| style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Diastolic murmur<br />
<br />
* Low pitched<br />
<br />
* Opening snap followed by decrescendo-crescendo rumbling murmur <br />
<br />
* Best heard with the bell of the stethoscope at apex at end-expiration in left lateral decubitus position <br />
<br />
* Intensity increases after a [[valsalva maneuver]], after exercise and after increased after load (eg., squatting, isometric hand grip) <br />
| style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* [[P mitrale]]<br />
* [[Atrial fibrillation]]: No P waves and irregularly irregular rhythm<br />
<br />
* [[Right axis deviation]]<br />
<br />
* Right ventricular hypertropy: Dominant R wave in V1 and V2<br />
| style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Straightening of the left border of the heart suggestive of enlargement of the [[left atrium]]<br />
<br />
* Double right heart border (Enlarged left atrium and normal right atrium) <br />
<br />
* Prominent left atrial appendage<br />
<br />
* Splaying of [[carina|subcarinal angle]] (>120 degrees)<br />
<br />
* Calcification of [[mitral valve]]<br />
<br />
* [[Kerley B lines]] <br />
<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Reduced valve leaflet mobility<br />
<br />
* Valve calcification <br />
<br />
* Doming of mitral valve<br />
<br />
* Valve thickening <br />
* Enlargement of left atrium <br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Right heart catheterization:'''<br />
* [[Pulmonary capillary wedge pressure]] (left atrial pressure) <br />
'''Left heart catheterization:'''<br />
* Pressures in left ventricle<br />
<br />
* Determines the gradient between the left and right atrium during ventricular diastole (marker of the severity of mitral stenosis)<br />
<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* [[Hemoptysis]] ([[heart failure]])<br />
<br />
* [[Ortner's syndrome]]<br />
|-<br />
| colspan="10" |<br />
|-<br />
|style="vertical-align: top;background: #DCDCDC; padding: 5px; text-align: center;" |[[Mitral Regurgitation]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* [[CAD]]<br />
<br />
* [[MI]]<br />
<br />
* [[Rheumatic fever]]<br />
<br />
* [[Endocarditis]]<br />
<br />
* [[Mitral valve prolapse]]<br />
<br />
* [[Cardiomyopathy]]<br />
<br />
* [[Radiation therapy]]<br />
<br />
* Trauma<br />
<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* [[Palpitations]]<br />
<br />
* Symptoms of heart failure in severe cases<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Palpation'''<br />
* Brisk carotid upstroke and hyperdymanic carotid impulse on palpation<br />
<br />
* Apical impulse is displaced to left<br />
<br />
* S3 and a palpable thrill<br />
'''Auscultation'''<br />
* Murmur<br />
<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* [[Holosystolic murmur]]<br />
<br />
* High pitched, blowing<br />
<br />
* Radiates to axilla<br />
<br />
* Best heard with the diaphragm of the stethoscope at apex in left lateral [[decubitus]] position<br />
<br />
* Intensity increases with hand grip or squatting <br />
<br />
* Decrease in intensity on standing or [[valsalva maneuver]] <br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* [[P mitrale]] in lead II<br />
* Increased QRS voltage<br />
* [[Right axis deviation]]<br />
* [[Atrial fibrillation]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Acute MR'''<br />
* [[Kerley B lines]]<br />
* No enlargement of cardiac silhouette<br />
'''Chronic MR'''<br />
* Enlarged cardiac silhouette<br />
* Straightening of left heart border<br />
* Splaying of subcarinal angle<br />
* Calcification of mitral annulus<br />
* Double right heart border<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Enlargement of left atrium and ventricle<br />
* Identify valve abnormality<br />
* Valve calcification<br />
* Severity of regurgitation<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Grading of MR is done with left ventriculography<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Decompensated and acute MR may lead to [[heart failure]]<br />
|-<br />
| colspan="10" |<br />
|-<br />
|style="vertical-align: top;background: #DCDCDC; padding: 5px; text-align: center;" |[[Atrial septal defect]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Frequent respiratory or lung infections<br />
* [[Dyspnea]]<br />
* Tiring when feeding (Infants)<br />
* Shortness of breath on exertion<br />
* [[Palpitations]]<br />
* Swelling of feet<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* [[Shortness of breath]]<br />
* [[Fatigue]]<br />
* [[Failure to thrive]]<br />
* Swelling of feet and abdomen ([[Right heart failure]])<br />
* [[Palpitations]]<br />
* Respiratory infections<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Inspection'''<br />
* Precordial bulge<br />
* Precordial lift<br />
'''Palpation'''<br />
* Right ventricular impulse<br />
* Pulmonary artery pulsations<br />
* Thrill<br />
'''Auscultation'''<br />
* Murmur<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Midsystolic (ejection systolic) murmur<br />
<br />
* Widely split, fixed S2<br />
<br />
* Upper left sternal border<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Normal <br />
* Prolonged PR interval<br />
* [[Right bundle branch block]]<br />
* ECG findings varies according to the underlying type of ASD<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
*Increased pulmonary markings<br />
*[[Cardiomegaly]]<br />
*Triangular appearance of heart<br />
*Schimitar sign<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Gold standard test for diagnosis of atrial septal defect (for more information click [[Atrial septal defect echocardiography]])<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Defect size<br />
* Pulmonary venous return<br />
* [[Pulmonary vascular resistance]]<br />
* [[Pulmonary artery hypertension]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Asymptomatic until later part of their life<br />
* May be associated with [[migraine with aura]]<br />
|-<br />
| colspan="10" |<br />
|-<br />
|style="vertical-align: top;background: #DCDCDC; padding: 5px; text-align: center;" |[[Atrial myxoma|Left Atrial Myxoma]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* [[Dyspnea]]<br />
* [[Orthopnea]]<br />
* [[Pulmonary edema]]<br />
* Hyperpigmentation of skin and endocrine activity<br />
* Cerebral [[embolism]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Symptoms may mimic mitral stenosis<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Skin'''<br />
* Signs of an embolic phenomenon<br />
* [[Raynaud's phenomenon]]<br />
* Swelling<br />
* Clubbing<br />
'''Auscultation:'''<br />
* Lung: Fine crepitations <br />
<br />
* Heart: Characteristic "tumor plop" <br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Early diastolic sound as "tumor plop"<br />
<br />
* Low frequency diastolic murmur may be heard if the tumor obstructing mitral valve <br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Often normal<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Often normal<br />
'''Rare findings:'''<br />
* [[cardiomegaly]]<br />
* Left atrial enlargement<br />
* tumor calcification etc.,<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Initial and most useful diagnostic study<br />
* For more information click [[Myxoma echocardiography or ultrasound]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Useful to detect vascular supply of the tumor by the coronary arteries <br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Associated with Carney complex (genetic predisposition)<br />
|-<br />
| colspan="10" |<br />
|-<br />
|style="vertical-align: top;background: #DCDCDC; padding: 5px; text-align: center;" |Prosthetic Valve Obstruction<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* History of valve replacement<br />
* Systemic embolism<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Shortness of breath<br />
* Fatigue<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Ausculation'''<br />
<br />
Muffling of murmur<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Muffling or disappearance of prosthetic sounds<br />
<br />
* Appearance of new regurgitant or obstructive murmur <br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Degree of stenosis<br />
* Assess thrombus size and location<br />
* Differentiate between thrombus, [[pannus]] and vegetations<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |Causes:<br />
* Thrombus<br />
* Pannus formation<br />
|-<br />
| colspan="10" |<br />
|-<br />
|style="vertical-align: top;background: #DCDCDC; padding: 5px; text-align: center;" |[[Cor Triatriatum]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Dyspnea on exertion <br />
* Recent onset of [[congestive heart failure]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Dsypnea on exertion<br />
* Orthopnea<br />
* Tachypnea<br />
* Palpitations<br />
* Growth failure<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Auscultation'''<br />
* Murmur<br />
'''Other findings'''<br />
* Signs of heart failure<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Diastolic murmur with loud P2<br />
<br />
* No opening snap or a loud S1<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |Non specific but may have<br />
* [[Right axis deviation]]<br />
* Right atrial enlargement<br />
* [[Right ventricular hypertrophy]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Normal cardiac silhouette<br />
* Hemodynamic changes similar to mitral stenosis (non specific findings)<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Direct visualization of membrane through the atrium<br />
* +/- visualization of accessory chamber<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Normal left ventricular hemodynamic profile with a trans atrial gradient<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |Types<br />
* Cor triatriatum sinistrum<br />
* Cor triatriatum dextrum<br />
|-<br />
| colspan="10" |<br />
|-<br />
|style="vertical-align: top;background: #DCDCDC; padding: 5px; text-align: center;" |Congenital Mitral Stenosis<br />
| style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Respiratory distress shortly after birth<br />
* Recurrent severe pulmonary infections<br />
* Other associated congenital cardiovascular anamolies<br />
* [[Atrial fibrillation]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
<br />
'''Infants:'''<br />
* Exhaustion and sweating on feeding<br />
* Rapid breathing<br />
* [[Failure to thrive]]<br />
* Pulmonary infections <br />
* Chronic cough<br />
'''Older patients:'''<br />
* Dyspnea<br />
* Orthopnea<br />
* Paroxysmal nocturnal dyspnea<br />
* Peripheral edema<br />
* Fatigue<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Auscultation'''<br />
* Murmur<br />
'''Other findings'''<br />
* Signs of heart failure<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Mild-Moderate'''<br />
* Loud S1<br />
<br />
* Loud P2<br />
<br />
* Low frequency diastolic murmur best heard at the apex <br />
'''Severe'''<br />
* Soft S1<br />
<br />
* Loud pulmonic component of S2 with minimal respiratory splitting of S2 <br />
<br />
* Holodiastolic murmur with presystolic accentuation best heard at the apex <br />
<br />
* Early diastolic murmur of pulmonic valve regurgitation <br />
<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
*Sharp P waves in leads I and II<br />
*Inversion of P wave in lead III<br />
*Marked Q waves in leads II and III<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Left atrial dilation<br />
* Moderate enlargement of right heart<br />
* Pulmonary venous congestion<br />
* Esophageal compression<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Reduced valve leaflet mobility<br />
* Left atrial size<br />
* Severity of mitral stenosis<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |Very rare condition<br />
|-<br />
| colspan="10" |<br />
|-<br />
|style="vertical-align: top;background: #DCDCDC; padding: 5px; text-align: center;" |Supravalvular Ring Mitral Stenosis<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Other associated congenital heart defects<br />
* Fatigue<br />
* Frequent respiratory infections<br />
* Failure to thrive<br />
* Poor feeding<br />
* Precocious congestive heart failure <br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Shortness of breath<br />
<br />
* Tachypnea<br />
* Dyspnea<br />
* Nocturnal cough<br />
* Heamoptysis<br />
* [[Syncope]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Auscultation:'''<br />
<br />
Lungs: Fine, crepitant rales and rhonchi or wheezes may be present<br />
<br />
Heart: Murmur<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* An apical mid diastolic murmur with presystolic accentuation<br />
<br />
* No opening snap<br />
<br />
* The murmur is more prominent if associated with [[VSD]] or [[PDA]]<br />
<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Left atrial and ventricular enlargement<br />
* Alveolar edema <br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Supramitral ring''':<br />
* Associated with normal mitral valve apparatus<br />
'''Intramitral ring:'''<br />
* Hypomobility of the posterior leaflet<br />
* Reduced interpapillary muscle distance<br />
* Reduced chordal length<br />
* Dominant papillary muscle<br />
* Hypoplastic mitral annulus<br />
(Difficult to visualize membrane <1mm in size)<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Persistently elevated pulmonary venous pressures<br />
* Increased pulmonary artery pressure<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Types'''<br />
* Supramitral<br />
* Intramitral<br />
It is attached between the opening of the atrial appendage and the mitral annulus which helps in differentiating with Cor triatriatum sinister.<br />
* Intramitral type is associated with shone complex<br />
|}</div>
Ifeoma odukwe
https://www.wikidoc.org/index.php?title=Sandbox:_Ifeoma&diff=1608423
Sandbox: Ifeoma
2020-05-16T15:40:08Z
<p>Ifeoma odukwe: /* Physiology */</p>
<hr />
<div>Wikidoc practice session<br />
<br />
==Pathophysiology==<br />
===Physiology===<br />
* Physiology shows you how you work.<br />
<br />
==Classification of dextrocardia==<br />
{| style="border: 0px; font-size: 90%; margin: 3px; width: 1000px"<br />
|valign=top|<br />
|+<br />
! style="background: #4479BA; width: 250px; color: #FFFFFF;"|'''Dextrocardia Types'''<br />
<br />
! style="background: #4479BA; width: 600px; color: #FFFFFF;"|'''Description'''<br />
<br />
|-<br />
<br />
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align=center | '''Dextrocardia with situs solitus '''|| style="padding: 5px 5px; background: #F5F5F5;" |<br />
:* Dextrocardia with normally related great arteries and D-transposition (complete transposition) or L-transposition (congenitally corrected transposition) of the great arteries. Some examples include dextrocardia with D-loop ventricles and normally related great arteries, with L-loop ventricles and L-TGA (congenitally corrected TGA).<br />
:* Embryologic failure of the final leftward shift of the ventricles during development results in dextrocardia with situs solitus, D-loop ventricles, and normally related great arteries.<br />
<br />
|-<br />
<br />
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align=center | '''Dextrocardia with situs inversus '''|| style="padding: 5px 5px; background: #F5F5F5;"|<br />
:* May present with dextrocardia with inversely related great arteries and D-transposition (congenitally corrected transposition) or L-transposition (“uncorrected” transposition) of the great arteries. An example is dextrocardia with D-loop ventricles and D-TGA (congenitally corrected TGA).<br />
<br />
|-<br />
<br />
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align=center | '''Dextrocardia with situs ambiguous (either polyspenia or asplenia)''' || style="padding: 5px 5px; background: #F5F5F5;"|<br />
:* Dextrocardia with any of the above relationships between the ventricles and great vessels.<br />
<br />
|-<br />
<br />
<br />
{|<br />
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"<br />
! rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;|Diseases<br />
| colspan="6" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;|'''Clinical manifestations'''<br />
! colspan="3" rowspan="2" |Para-clinical findings<br />
| colspan="1" rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;|'''Gold standard'''<br />
! rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;|Additional findings<br />
|-<br />
| colspan="3" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;|'''Symptoms'''<br />
! colspan="3" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;|Physical examination<br />
|-<br />
! colspan="3" style="background: #4479BA; color: #FFFFFF; text-align: center;|Imaging<br />
|- <br />
! style="background: #4479BA; color: #FFFFFF; text-align: center;|Exertional dyspnea<br />
! colspan="1" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;|Failure to thrive<br />
! style="background: #4479BA; color: #FFFFFF; text-align: center;|Recurrent respiratory infections<br />
! style="background: #4479BA; color: #FFFFFF; text-align: center;|Murmur on auscultation<br />
! colspan="1" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;|Peripheral edema<br />
! style="background: #4479BA; color: #FFFFFF; text-align: center;|Clubbing<br />
! style="background: #4479BA; color: #FFFFFF; text-align: center;|Echocardiography<br />
! style="background: #4479BA; color: #FFFFFF; text-align: center;|Chest x-ray<br />
! style="background: #4479BA; color: #FFFFFF; text-align: center;|Cardiac CT<br />
|-<br />
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Patent foramen ovale]]<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Appearance of at least 3 micro-bubbles in the left atrium within three cardiac cycles after complete opacification of the right atrium<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | Non specific<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | <br />
* A contrast agent jet from the left atrium to the right atrium toward the inferior vena cava with channel-like appearance of the interatrial septum<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Echocardiogram<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* It is associated with paradoxical embolism, migraine headache, and decompression sickness in divers<br />
|-<br />
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Atrial septal defect]]<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/−<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/−<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/− <br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Systolic flow murmur in the upper left sternal border<br />
* Wide, fixed splitting of S2<br />
* Diastolic flow rumble across the tricuspid valve<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/−<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/−<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Hypermobile interatrial septum<br />
* Abrupt septal irregularity<br />
* Right atrial and ventricular volume overload<br />
* Pulmonary artery dilatation<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Cardiomegaly <br />
* Pulmonary artery enlargement/increased pulmonary vascularity<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Enlargement of the right atrium and ventricle<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Echocardiogram<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Atrial septal defect is classified into 5 types including ostium primum defect, ostium secundum defect, superior sinus venosus defect, inferior sinus venosus defect, and coronary sinus defect<br />
|-<br />
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Ventricular septal defect]]<br />
| style="background: #F5F5F5; padding: 5px;" |-/+<br />
| style="background: #F5F5F5; padding: 5px;" |-/+<br />
| style="background: #F5F5F5; padding: 5px;" |After Eisenmenger syndrome<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Holosystolic murmur<br />
* May mimic aortic stenosis(mid/end dyastolic murmur due to increased pulmonary circulation)<br />
| style="background: #F5F5F5; padding: 5px;" |-/+<br />
| style="background: #F5F5F5; padding: 5px;" |-/+<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Defect localization<br />
*septal dropout in the area adjacent to the tricuspid septal leaflet and below the right border of the aortic annulus<br />
* Direction of jet<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* [[Cardiomegaly]] in large VSD<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Direct visualisation of murmur<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Echocardiogram<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"<br />
!Diseases<br />
!Exertional dyspnea<br />
! colspan="1" rowspan="1" |Failure to thrive<br />
!Recurrent respiratory infections<br />
!Murmur on auscultation<br />
! colspan="1" rowspan="1" |Peripheral edema<br />
!Clubbing<br />
!Echocardiography<br />
!Chest x-ray<br />
!Cardiac CT<br />
|'''Gold standard'''<br />
!Additional findings<br />
|-<br />
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Patent ductus arteriosus]]<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Not at beginning<br />
* May be produced during the course of disease <br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Depends on the size<br />
| style="background: #F5F5F5; padding: 5px;" | -<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Continuous machine-like murmur<br />
| style="background: #F5F5F5; padding: 5px;" |-<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* May be present by progressing<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Golden standard <br />
* In color-Doppler visualization of flow through the patent duct which has a high velocity<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Non-specific<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Used for determining Krichenko classification<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Echocardiogram<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Krichenko criteria for classification is a very important factor for treatment<br />
|-<br />
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Aortic coarctation|Coarctation of the aorta]]<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/−<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/−<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Systolic murmur over the upper sternal border with radiation to the back<br />
*Murmur of mitral regurgitation (holosystolic murmur best heard at the apex)<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Narrowing of the aortic arch at the level of the isthmus<br />
* Left ventricular hypertrophy<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Notching of the posterior fourth to eighth ribs due to dilated intercostal arteries<br />
* Indentation of the aorta at the site of coarctation with pre- and post-stenotic dilation of the aorta (classic "3 sign")<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Dilation of the intercostal arteries<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Echocardiogram<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
*Patients present with arm-leg blood pressure gradient of >20mmHg<br />
|-<br />
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Aortic stenosis]]<br />
| style="background: #F5F5F5; padding: 5px;" |+<br />
| style="background: #F5F5F5; padding: 5px;" |+<br />
| style="background: #F5F5F5; padding: 5px;" |+<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Crescendo-decrescendo mid-systolic (or ejection systolic) murmur<br />
| style="background: #F5F5F5; padding: 5px;" |+/-<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Depending on severity<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Used for finding the location of stenosis<br />
* Finding severity<br />
* Evaluating the flow jet with color-Doppler ultrasound technique<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Non-specific at the beginning<br />
* At progressed stage calcification of the valve and cardiomegally<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
*[[Aortic calcification|Calcification score]]<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* MRI<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* MRI provides a more detailed structural and dynamic assessment of the aortic valve and left ventricle, in particular<br />
|-<br />
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Pulmonary valve stenosis|Pulmonary stenosis]]<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Depending on severity<br />
| style="background: #F5F5F5; padding: 5px;" | -<br />
| style="background: #F5F5F5; padding: 5px;" | -/+<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Continuous systolic murmur<br />
| style="background: #F5F5F5; padding: 5px;" |-<br />
| style="background: #F5F5F5; padding: 5px;" | -/+<br />
| style="background: #F5F5F5; padding: 5px;" | <br />
* Right atrial hypertrophy<br />
| style="background: #F5F5F5; padding: 5px;" | <br />
* Non-specific<br />
| style="background: #F5F5F5; padding: 5px;" | <br />
* Direct visualization of stenosis<br />
| style="background: #F5F5F5; padding: 5px;" | <br />
* Echocardiogram<br />
| style="background: #F5F5F5; padding: 5px;" | <br />
|}<br />
<br />
<br />
<br />
<br />
<br />
<br />
<br />
<br />
<br />
<br />
<br />
{| class="wikitable"<br />
|+<br />
!Diseases<br />
!Pathophysiology<br />
!Shunt<br />
!Symptoms<br />
!Diagnosis<br />
!Echocardiography findings<br />
!Physical examination<br />
!Treatment<br />
!Complications<br />
|-<br />
|Patent foramen ovale<br />
|<br />
* Failure of fusion of the septum primum and septum secundum leading to a flap valve opening.<br />
|<br />
* Right-to-left shunt<br />
<br />
* More prominent with increased right atrial pressure.<br />
|<br />
* Majority of patients are asymptomatic<br />
|<br />
* TEE (Gold standard)<br />
<br />
* TTE<br />
<br />
* TCD<br />
|<br />
* Appearance of at least 3 micro-bubbles in the left atrium within three cardiac cycles after the complete opacification of the right atrium<br />
|<br />
|<br />
* Percutaneous closure<br />
* Anticoagulants<br />
* Antiplatelets<br />
|<br />
* Paradoxical embolism<br />
<br />
* Migraine with aura<br />
*Decompression sickness in divers<br />
*Platypnea-orthodeoxia syndrome<br /><br />
|-<br />
|Atrial septal defect<br />
|<br />
* '''Ostium secundum defect''': Failure of the septum secundum to occlude the ostium secundum.<br />
<br />
* '''Ostium primum defect''': Failure of the ostium primum to fuse with the endocardial cushions.<br />
<br />
* '''Superior sinus venosus defect''': The orifice of the superior vena cava overrides the atrial septum above the fossa ovalis.<br />
<br />
* '''Inferior sinus venosus defect''': The orifice of the inferior vena cava overrides the left and right atrium.<br />
*'''Coronary sinus defect''': Absence of a portion of the common wall that separates the coronary sinus and the left atrium.<br />
|<br />
* Continuous left-to-right shunt<br />
|<br />
* Failure to thrive, tachypnea, recurrent respiratory infections, heart failure<br />
<br />
* Commonly asymptomatic during childhood and adolescence<br />
*Adults with large shunts may become symptomatic in the fourth decade presenting with fatigue, exercise intolerance, palpitations, syncope, and shortness of breath.<br />
<br />
*<br />
|<br />
* TTE (Gold standard)<br />
*Cardiac CT<br />
*Cardiac MRI<br />
|<br />
* Hypermobile interatrial septum<br />
* Abrupt septal irregularity<br />
* Right atrial and ventricular volume overload<br />
* Pulmonary artery dilation<br />
*'''Coronary sinus defect''': Enlarged ostium of the coronary sinus and unroofing of the terminal portion of the coronary sinus<br />
|<br />
* Systolic flow murmur in the pulmonary valve region<br />
*Wide, fixed splitting of S2<br />
*Diastolic flow rumble across the tricuspid valve<br />
*Right ventricular heave <br />
|<br />
* Spontaneous closure<br />
*Percutaneous transcatheter closure<br />
*Surgical closure<br />
|<br />
* Right sided heart failure<br />
* Peripheral edema<br />
* Eisenmenger syndrome (cyanosis)<br />
* Paradoxical emboli<br />
* Pulmonary hypertension<br />
|-<br />
|Pulmonary ateriovenous fistula<br />
|<br />
* Abnormal blood vessel(s) connecting the pulmonary arteries and veins directly without interposition of pulmonary capillaries<br />
|<br />
* Right-to-left shunt between the pulmonary artery and pulmonary vein<br />
|<br />
* Symptoms may occur only after the second decade<br />
*Cyanosis<br />
*Hemoptysis<br />
|<br />
* Chest CT<br />
*Pulmonary arteriogram<br />
|<br />
* Appearance of contrast bubbles in the left atrium three to five cardiac cycles after appearance in the right atrium<br />
|<br />
* Clubbing<br />
*Systolic/continuous murmur<br />
|<br />
* Embolization<br />
* Surgical resection<br />
|<br />
* Cerebral ischemia/abscess<br />
*Hemothorax<br />
|}<br />
<br />
==Differential table for aortic stenosis==<br />
<br />
{| class="wikitable"<br />
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;|Diseases<br />
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;|History<br />
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;|Symptoms<br />
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;|Physical Examination<br />
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;|Murmur<br />
! colspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;|Diagnosis<br />
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;|Other Findings<br />
|- style="background: #DCDCDC; padding: 5px; text-align: center;"<br />
!style="background: #4479BA; color: #FFFFFF; text-align: center;|ECG<br />
!style="background: #4479BA; color: #FFFFFF; text-align: center;|CXR<br />
!style="background: #4479BA; color: #FFFFFF; text-align: center;|Echocardiogram<br />
!style="background: #4479BA; color: #FFFFFF; text-align: center;|Cardiac Catheterization<br />
|-<br />
|style="background: #DCDCDC; padding: 5px; text-align: center;" |Aortic stenosis<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Age (aortic valve calcification)<br />
*Syncope<br />
*Orthopnea<br />
*Paroxysmal nocturnal dyspnea<br />
*Acute rheumatic fever<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Chest pain<br />
*Dyspnea on exertion<br />
*Palpitations<br />
*Symptoms of heart failure<br />
| style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Pulsus parvus et tardus<br />
*Pulmonary rales<br />
*Peripheral edema (In CHF patients)<br />
*Jugular venous distension<br />
*Enlarged and laterally displaced point of maximal impulse<br />
<br />
*<br />
| style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Crescendo-decrescendo systolic murmur<br />
*Best heard at the right upper sternal border<br />
*Radiation to the carotid arteries<br />
*Increases with squatting<br />
*Decreases with valsalva maneuver<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Left ventricular hypertrophy''':<br />
<br />
* Wide QRS complex (especially in leads V1-V6)<br />
*ST depression in leads V5-V6<br />
*Left axis deviation<br />
* <br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Enlarged left ventricle<br />
* Enlarged left atrium and pulmonary artery in severe cases<br />
*Calcification of the aortic valve<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Thickening and calcification of the aortic valve<br />
*Left ventricular hypertrophy<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Left heart catheterization:'''<br />
<br />
* Left ventricular and aortic pressures<br />
*The left ventricle generates higher pressures than what is transmitted to the aorta<br />
| style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Associated with von Willibrand disease<br />
|-<br />
| colspan="10" |<br />
|-<br />
|style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Mitral Stenosis]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Age ( Mitral annular calcification in older patients)<br />
<br />
* [[Rheumatic fever]]<br />
<br />
* [[Endocarditis]]<br />
<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* [[Dyspnea on exertion]]<br />
<br />
* [[Paroxysmal nocturnal dyspnea]]<br />
<br />
* [[Orthopnea]]<br />
<br />
* New onset [[atrial fibrillation]]<br />
<br />
| style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Mitral facies<br />
<br />
* Heart murmur<br />
<br />
* [[JVD|Jugular vein distension]]<br />
<br />
* Apical impulse displaced laterally or not palpable <br />
<br />
* Diastolic thrill at the apex <br />
<br />
* Signs of heart failure in severe cases<br />
| style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Diastolic murmur<br />
<br />
* Low pitched<br />
<br />
* Opening snap followed by decrescendo-crescendo rumbling murmur <br />
<br />
* Best heard with the bell of the stethoscope at apex at end-expiration in left lateral decubitus position <br />
<br />
* Intensity increases after a [[valsalva maneuver]], after exercise and after increased after load (eg., squatting, isometric hand grip) <br />
| style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* [[P mitrale]]<br />
* [[Atrial fibrillation]]: No P waves and irregularly irregular rhythm<br />
<br />
* [[Right axis deviation]]<br />
<br />
* Right ventricular hypertropy: Dominant R wave in V1 and V2<br />
| style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Straightening of the left border of the heart suggestive of enlargement of the [[left atrium]]<br />
<br />
* Double right heart border (Enlarged left atrium and normal right atrium) <br />
<br />
* Prominent left atrial appendage<br />
<br />
* Splaying of [[carina|subcarinal angle]] (>120 degrees)<br />
<br />
* Calcification of [[mitral valve]]<br />
<br />
* [[Kerley B lines]] <br />
<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Reduced valve leaflet mobility<br />
<br />
* Valve calcification <br />
<br />
* Doming of mitral valve<br />
<br />
* Valve thickening <br />
* Enlargement of left atrium <br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Right heart catheterization:'''<br />
* [[Pulmonary capillary wedge pressure]] (left atrial pressure) <br />
'''Left heart catheterization:'''<br />
* Pressures in left ventricle<br />
<br />
* Determines the gradient between the left and right atrium during ventricular diastole (marker of the severity of mitral stenosis)<br />
<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* [[Hemoptysis]] ([[heart failure]])<br />
<br />
* [[Ortner's syndrome]]<br />
|-<br />
| colspan="10" |<br />
|-<br />
|style="vertical-align: top;background: #DCDCDC; padding: 5px; text-align: center;" |[[Mitral Regurgitation]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* [[CAD]]<br />
<br />
* [[MI]]<br />
<br />
* [[Rheumatic fever]]<br />
<br />
* [[Endocarditis]]<br />
<br />
* [[Mitral valve prolapse]]<br />
<br />
* [[Cardiomyopathy]]<br />
<br />
* [[Radiation therapy]]<br />
<br />
* Trauma<br />
<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* [[Palpitations]]<br />
<br />
* Symptoms of heart failure in severe cases<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Palpation'''<br />
* Brisk carotid upstroke and hyperdymanic carotid impulse on palpation<br />
<br />
* Apical impulse is displaced to left<br />
<br />
* S3 and a palpable thrill<br />
'''Auscultation'''<br />
* Murmur<br />
<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* [[Holosystolic murmur]]<br />
<br />
* High pitched, blowing<br />
<br />
* Radiates to axilla<br />
<br />
* Best heard with the diaphragm of the stethoscope at apex in left lateral [[decubitus]] position<br />
<br />
* Intensity increases with hand grip or squatting <br />
<br />
* Decrease in intensity on standing or [[valsalva maneuver]] <br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* [[P mitrale]] in lead II<br />
* Increased QRS voltage<br />
* [[Right axis deviation]]<br />
* [[Atrial fibrillation]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Acute MR'''<br />
* [[Kerley B lines]]<br />
* No enlargement of cardiac silhouette<br />
'''Chronic MR'''<br />
* Enlarged cardiac silhouette<br />
* Straightening of left heart border<br />
* Splaying of subcarinal angle<br />
* Calcification of mitral annulus<br />
* Double right heart border<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Enlargement of left atrium and ventricle<br />
* Identify valve abnormality<br />
* Valve calcification<br />
* Severity of regurgitation<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Grading of MR is done with left ventriculography<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Decompensated and acute MR may lead to [[heart failure]]<br />
|-<br />
| colspan="10" |<br />
|-<br />
|style="vertical-align: top;background: #DCDCDC; padding: 5px; text-align: center;" |[[Atrial septal defect]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Frequent respiratory or lung infections<br />
* [[Dyspnea]]<br />
* Tiring when feeding (Infants)<br />
* Shortness of breath on exertion<br />
* [[Palpitations]]<br />
* Swelling of feet<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* [[Shortness of breath]]<br />
* [[Fatigue]]<br />
* [[Failure to thrive]]<br />
* Swelling of feet and abdomen ([[Right heart failure]])<br />
* [[Palpitations]]<br />
* Respiratory infections<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Inspection'''<br />
* Precordial bulge<br />
* Precordial lift<br />
'''Palpation'''<br />
* Right ventricular impulse<br />
* Pulmonary artery pulsations<br />
* Thrill<br />
'''Auscultation'''<br />
* Murmur<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Midsystolic (ejection systolic) murmur<br />
<br />
* Widely split, fixed S2<br />
<br />
* Upper left sternal border<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Normal <br />
* Prolonged PR interval<br />
* [[Right bundle branch block]]<br />
* ECG findings varies according to the underlying type of ASD<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
*Increased pulmonary markings<br />
*[[Cardiomegaly]]<br />
*Triangular appearance of heart<br />
*Schimitar sign<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Gold standard test for diagnosis of atrial septal defect (for more information click [[Atrial septal defect echocardiography]])<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Defect size<br />
* Pulmonary venous return<br />
* [[Pulmonary vascular resistance]]<br />
* [[Pulmonary artery hypertension]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Asymptomatic until later part of their life<br />
* May be associated with [[migraine with aura]]<br />
|-<br />
| colspan="10" |<br />
|-<br />
|style="vertical-align: top;background: #DCDCDC; padding: 5px; text-align: center;" |[[Atrial myxoma|Left Atrial Myxoma]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* [[Dyspnea]]<br />
* [[Orthopnea]]<br />
* [[Pulmonary edema]]<br />
* Hyperpigmentation of skin and endocrine activity<br />
* Cerebral [[embolism]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Symptoms may mimic mitral stenosis<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Skin'''<br />
* Signs of an embolic phenomenon<br />
* [[Raynaud's phenomenon]]<br />
* Swelling<br />
* Clubbing<br />
'''Auscultation:'''<br />
* Lung: Fine crepitations <br />
<br />
* Heart: Characteristic "tumor plop" <br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Early diastolic sound as "tumor plop"<br />
<br />
* Low frequency diastolic murmur may be heard if the tumor obstructing mitral valve <br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Often normal<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Often normal<br />
'''Rare findings:'''<br />
* [[cardiomegaly]]<br />
* Left atrial enlargement<br />
* tumor calcification etc.,<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Initial and most useful diagnostic study<br />
* For more information click [[Myxoma echocardiography or ultrasound]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Useful to detect vascular supply of the tumor by the coronary arteries <br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Associated with Carney complex (genetic predisposition)<br />
|-<br />
| colspan="10" |<br />
|-<br />
|style="vertical-align: top;background: #DCDCDC; padding: 5px; text-align: center;" |Prosthetic Valve Obstruction<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* History of valve replacement<br />
* Systemic embolism<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Shortness of breath<br />
* Fatigue<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Ausculation'''<br />
<br />
Muffling of murmur<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Muffling or disappearance of prosthetic sounds<br />
<br />
* Appearance of new regurgitant or obstructive murmur <br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Degree of stenosis<br />
* Assess thrombus size and location<br />
* Differentiate between thrombus, [[pannus]] and vegetations<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |Causes:<br />
* Thrombus<br />
* Pannus formation<br />
|-<br />
| colspan="10" |<br />
|-<br />
|style="vertical-align: top;background: #DCDCDC; padding: 5px; text-align: center;" |[[Cor Triatriatum]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Dyspnea on exertion <br />
* Recent onset of [[congestive heart failure]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Dsypnea on exertion<br />
* Orthopnea<br />
* Tachypnea<br />
* Palpitations<br />
* Growth failure<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Auscultation'''<br />
* Murmur<br />
'''Other findings'''<br />
* Signs of heart failure<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Diastolic murmur with loud P2<br />
<br />
* No opening snap or a loud S1<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |Non specific but may have<br />
* [[Right axis deviation]]<br />
* Right atrial enlargement<br />
* [[Right ventricular hypertrophy]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Normal cardiac silhouette<br />
* Hemodynamic changes similar to mitral stenosis (non specific findings)<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Direct visualization of membrane through the atrium<br />
* +/- visualization of accessory chamber<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Normal left ventricular hemodynamic profile with a trans atrial gradient<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |Types<br />
* Cor triatriatum sinistrum<br />
* Cor triatriatum dextrum<br />
|-<br />
| colspan="10" |<br />
|-<br />
|style="vertical-align: top;background: #DCDCDC; padding: 5px; text-align: center;" |Congenital Mitral Stenosis<br />
| style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Respiratory distress shortly after birth<br />
* Recurrent severe pulmonary infections<br />
* Other associated congenital cardiovascular anamolies<br />
* [[Atrial fibrillation]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
<br />
'''Infants:'''<br />
* Exhaustion and sweating on feeding<br />
* Rapid breathing<br />
* [[Failure to thrive]]<br />
* Pulmonary infections <br />
* Chronic cough<br />
'''Older patients:'''<br />
* Dyspnea<br />
* Orthopnea<br />
* Paroxysmal nocturnal dyspnea<br />
* Peripheral edema<br />
* Fatigue<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Auscultation'''<br />
* Murmur<br />
'''Other findings'''<br />
* Signs of heart failure<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Mild-Moderate'''<br />
* Loud S1<br />
<br />
* Loud P2<br />
<br />
* Low frequency diastolic murmur best heard at the apex <br />
'''Severe'''<br />
* Soft S1<br />
<br />
* Loud pulmonic component of S2 with minimal respiratory splitting of S2 <br />
<br />
* Holodiastolic murmur with presystolic accentuation best heard at the apex <br />
<br />
* Early diastolic murmur of pulmonic valve regurgitation <br />
<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
*Sharp P waves in leads I and II<br />
*Inversion of P wave in lead III<br />
*Marked Q waves in leads II and III<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Left atrial dilation<br />
* Moderate enlargement of right heart<br />
* Pulmonary venous congestion<br />
* Esophageal compression<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Reduced valve leaflet mobility<br />
* Left atrial size<br />
* Severity of mitral stenosis<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |Very rare condition<br />
|-<br />
| colspan="10" |<br />
|-<br />
|style="vertical-align: top;background: #DCDCDC; padding: 5px; text-align: center;" |Supravalvular Ring Mitral Stenosis<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Other associated congenital heart defects<br />
* Fatigue<br />
* Frequent respiratory infections<br />
* Failure to thrive<br />
* Poor feeding<br />
* Precocious congestive heart failure <br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Shortness of breath<br />
<br />
* Tachypnea<br />
* Dyspnea<br />
* Nocturnal cough<br />
* Heamoptysis<br />
* [[Syncope]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Auscultation:'''<br />
<br />
Lungs: Fine, crepitant rales and rhonchi or wheezes may be present<br />
<br />
Heart: Murmur<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* An apical mid diastolic murmur with presystolic accentuation<br />
<br />
* No opening snap<br />
<br />
* The murmur is more prominent if associated with [[VSD]] or [[PDA]]<br />
<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Left atrial and ventricular enlargement<br />
* Alveolar edema <br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Supramitral ring''':<br />
* Associated with normal mitral valve apparatus<br />
'''Intramitral ring:'''<br />
* Hypomobility of the posterior leaflet<br />
* Reduced interpapillary muscle distance<br />
* Reduced chordal length<br />
* Dominant papillary muscle<br />
* Hypoplastic mitral annulus<br />
(Difficult to visualize membrane <1mm in size)<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Persistently elevated pulmonary venous pressures<br />
* Increased pulmonary artery pressure<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Types'''<br />
* Supramitral<br />
* Intramitral<br />
It is attached between the opening of the atrial appendage and the mitral annulus which helps in differentiating with Cor triatriatum sinister.<br />
* Intramitral type is associated with shone complex<br />
|}</div>
Ifeoma odukwe
https://www.wikidoc.org/index.php?title=Sandbox:_Ifeoma&diff=1608422
Sandbox: Ifeoma
2020-05-16T15:38:23Z
<p>Ifeoma odukwe: /* Physiology */</p>
<hr />
<div>Wikidoc practice session<br />
<br />
==Pathophysiology==<br />
===Physiology===<br />
kvs vkjsvfnssjk ,knk j vslksv ,lvs<br />
<br />
==Classification of dextrocardia==<br />
{| style="border: 0px; font-size: 90%; margin: 3px; width: 1000px"<br />
|valign=top|<br />
|+<br />
! style="background: #4479BA; width: 250px; color: #FFFFFF;"|'''Dextrocardia Types'''<br />
<br />
! style="background: #4479BA; width: 600px; color: #FFFFFF;"|'''Description'''<br />
<br />
|-<br />
<br />
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align=center | '''Dextrocardia with situs solitus '''|| style="padding: 5px 5px; background: #F5F5F5;" |<br />
:* Dextrocardia with normally related great arteries and D-transposition (complete transposition) or L-transposition (congenitally corrected transposition) of the great arteries. Some examples include dextrocardia with D-loop ventricles and normally related great arteries, with L-loop ventricles and L-TGA (congenitally corrected TGA).<br />
:* Embryologic failure of the final leftward shift of the ventricles during development results in dextrocardia with situs solitus, D-loop ventricles, and normally related great arteries.<br />
<br />
|-<br />
<br />
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align=center | '''Dextrocardia with situs inversus '''|| style="padding: 5px 5px; background: #F5F5F5;"|<br />
:* May present with dextrocardia with inversely related great arteries and D-transposition (congenitally corrected transposition) or L-transposition (“uncorrected” transposition) of the great arteries. An example is dextrocardia with D-loop ventricles and D-TGA (congenitally corrected TGA).<br />
<br />
|-<br />
<br />
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align=center | '''Dextrocardia with situs ambiguous (either polyspenia or asplenia)''' || style="padding: 5px 5px; background: #F5F5F5;"|<br />
:* Dextrocardia with any of the above relationships between the ventricles and great vessels.<br />
<br />
|-<br />
<br />
<br />
{|<br />
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"<br />
! rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;|Diseases<br />
| colspan="6" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;|'''Clinical manifestations'''<br />
! colspan="3" rowspan="2" |Para-clinical findings<br />
| colspan="1" rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;|'''Gold standard'''<br />
! rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;|Additional findings<br />
|-<br />
| colspan="3" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;|'''Symptoms'''<br />
! colspan="3" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;|Physical examination<br />
|-<br />
! colspan="3" style="background: #4479BA; color: #FFFFFF; text-align: center;|Imaging<br />
|- <br />
! style="background: #4479BA; color: #FFFFFF; text-align: center;|Exertional dyspnea<br />
! colspan="1" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;|Failure to thrive<br />
! style="background: #4479BA; color: #FFFFFF; text-align: center;|Recurrent respiratory infections<br />
! style="background: #4479BA; color: #FFFFFF; text-align: center;|Murmur on auscultation<br />
! colspan="1" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;|Peripheral edema<br />
! style="background: #4479BA; color: #FFFFFF; text-align: center;|Clubbing<br />
! style="background: #4479BA; color: #FFFFFF; text-align: center;|Echocardiography<br />
! style="background: #4479BA; color: #FFFFFF; text-align: center;|Chest x-ray<br />
! style="background: #4479BA; color: #FFFFFF; text-align: center;|Cardiac CT<br />
|-<br />
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Patent foramen ovale]]<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Appearance of at least 3 micro-bubbles in the left atrium within three cardiac cycles after complete opacification of the right atrium<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | Non specific<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | <br />
* A contrast agent jet from the left atrium to the right atrium toward the inferior vena cava with channel-like appearance of the interatrial septum<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Echocardiogram<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* It is associated with paradoxical embolism, migraine headache, and decompression sickness in divers<br />
|-<br />
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Atrial septal defect]]<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/−<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/−<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/− <br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Systolic flow murmur in the upper left sternal border<br />
* Wide, fixed splitting of S2<br />
* Diastolic flow rumble across the tricuspid valve<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/−<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/−<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Hypermobile interatrial septum<br />
* Abrupt septal irregularity<br />
* Right atrial and ventricular volume overload<br />
* Pulmonary artery dilatation<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Cardiomegaly <br />
* Pulmonary artery enlargement/increased pulmonary vascularity<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Enlargement of the right atrium and ventricle<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Echocardiogram<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Atrial septal defect is classified into 5 types including ostium primum defect, ostium secundum defect, superior sinus venosus defect, inferior sinus venosus defect, and coronary sinus defect<br />
|-<br />
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Ventricular septal defect]]<br />
| style="background: #F5F5F5; padding: 5px;" |-/+<br />
| style="background: #F5F5F5; padding: 5px;" |-/+<br />
| style="background: #F5F5F5; padding: 5px;" |After Eisenmenger syndrome<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Holosystolic murmur<br />
* May mimic aortic stenosis(mid/end dyastolic murmur due to increased pulmonary circulation)<br />
| style="background: #F5F5F5; padding: 5px;" |-/+<br />
| style="background: #F5F5F5; padding: 5px;" |-/+<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Defect localization<br />
*septal dropout in the area adjacent to the tricuspid septal leaflet and below the right border of the aortic annulus<br />
* Direction of jet<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* [[Cardiomegaly]] in large VSD<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Direct visualisation of murmur<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Echocardiogram<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"<br />
!Diseases<br />
!Exertional dyspnea<br />
! colspan="1" rowspan="1" |Failure to thrive<br />
!Recurrent respiratory infections<br />
!Murmur on auscultation<br />
! colspan="1" rowspan="1" |Peripheral edema<br />
!Clubbing<br />
!Echocardiography<br />
!Chest x-ray<br />
!Cardiac CT<br />
|'''Gold standard'''<br />
!Additional findings<br />
|-<br />
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Patent ductus arteriosus]]<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Not at beginning<br />
* May be produced during the course of disease <br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Depends on the size<br />
| style="background: #F5F5F5; padding: 5px;" | -<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Continuous machine-like murmur<br />
| style="background: #F5F5F5; padding: 5px;" |-<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* May be present by progressing<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Golden standard <br />
* In color-Doppler visualization of flow through the patent duct which has a high velocity<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Non-specific<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Used for determining Krichenko classification<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Echocardiogram<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Krichenko criteria for classification is a very important factor for treatment<br />
|-<br />
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Aortic coarctation|Coarctation of the aorta]]<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/−<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/−<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Systolic murmur over the upper sternal border with radiation to the back<br />
*Murmur of mitral regurgitation (holosystolic murmur best heard at the apex)<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Narrowing of the aortic arch at the level of the isthmus<br />
* Left ventricular hypertrophy<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Notching of the posterior fourth to eighth ribs due to dilated intercostal arteries<br />
* Indentation of the aorta at the site of coarctation with pre- and post-stenotic dilation of the aorta (classic "3 sign")<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Dilation of the intercostal arteries<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Echocardiogram<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
*Patients present with arm-leg blood pressure gradient of >20mmHg<br />
|-<br />
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Aortic stenosis]]<br />
| style="background: #F5F5F5; padding: 5px;" |+<br />
| style="background: #F5F5F5; padding: 5px;" |+<br />
| style="background: #F5F5F5; padding: 5px;" |+<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Crescendo-decrescendo mid-systolic (or ejection systolic) murmur<br />
| style="background: #F5F5F5; padding: 5px;" |+/-<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Depending on severity<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Used for finding the location of stenosis<br />
* Finding severity<br />
* Evaluating the flow jet with color-Doppler ultrasound technique<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Non-specific at the beginning<br />
* At progressed stage calcification of the valve and cardiomegally<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
*[[Aortic calcification|Calcification score]]<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* MRI<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* MRI provides a more detailed structural and dynamic assessment of the aortic valve and left ventricle, in particular<br />
|-<br />
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Pulmonary valve stenosis|Pulmonary stenosis]]<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Depending on severity<br />
| style="background: #F5F5F5; padding: 5px;" | -<br />
| style="background: #F5F5F5; padding: 5px;" | -/+<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Continuous systolic murmur<br />
| style="background: #F5F5F5; padding: 5px;" |-<br />
| style="background: #F5F5F5; padding: 5px;" | -/+<br />
| style="background: #F5F5F5; padding: 5px;" | <br />
* Right atrial hypertrophy<br />
| style="background: #F5F5F5; padding: 5px;" | <br />
* Non-specific<br />
| style="background: #F5F5F5; padding: 5px;" | <br />
* Direct visualization of stenosis<br />
| style="background: #F5F5F5; padding: 5px;" | <br />
* Echocardiogram<br />
| style="background: #F5F5F5; padding: 5px;" | <br />
|}<br />
<br />
<br />
<br />
<br />
<br />
<br />
<br />
<br />
<br />
<br />
<br />
{| class="wikitable"<br />
|+<br />
!Diseases<br />
!Pathophysiology<br />
!Shunt<br />
!Symptoms<br />
!Diagnosis<br />
!Echocardiography findings<br />
!Physical examination<br />
!Treatment<br />
!Complications<br />
|-<br />
|Patent foramen ovale<br />
|<br />
* Failure of fusion of the septum primum and septum secundum leading to a flap valve opening.<br />
|<br />
* Right-to-left shunt<br />
<br />
* More prominent with increased right atrial pressure.<br />
|<br />
* Majority of patients are asymptomatic<br />
|<br />
* TEE (Gold standard)<br />
<br />
* TTE<br />
<br />
* TCD<br />
|<br />
* Appearance of at least 3 micro-bubbles in the left atrium within three cardiac cycles after the complete opacification of the right atrium<br />
|<br />
|<br />
* Percutaneous closure<br />
* Anticoagulants<br />
* Antiplatelets<br />
|<br />
* Paradoxical embolism<br />
<br />
* Migraine with aura<br />
*Decompression sickness in divers<br />
*Platypnea-orthodeoxia syndrome<br /><br />
|-<br />
|Atrial septal defect<br />
|<br />
* '''Ostium secundum defect''': Failure of the septum secundum to occlude the ostium secundum.<br />
<br />
* '''Ostium primum defect''': Failure of the ostium primum to fuse with the endocardial cushions.<br />
<br />
* '''Superior sinus venosus defect''': The orifice of the superior vena cava overrides the atrial septum above the fossa ovalis.<br />
<br />
* '''Inferior sinus venosus defect''': The orifice of the inferior vena cava overrides the left and right atrium.<br />
*'''Coronary sinus defect''': Absence of a portion of the common wall that separates the coronary sinus and the left atrium.<br />
|<br />
* Continuous left-to-right shunt<br />
|<br />
* Failure to thrive, tachypnea, recurrent respiratory infections, heart failure<br />
<br />
* Commonly asymptomatic during childhood and adolescence<br />
*Adults with large shunts may become symptomatic in the fourth decade presenting with fatigue, exercise intolerance, palpitations, syncope, and shortness of breath.<br />
<br />
*<br />
|<br />
* TTE (Gold standard)<br />
*Cardiac CT<br />
*Cardiac MRI<br />
|<br />
* Hypermobile interatrial septum<br />
* Abrupt septal irregularity<br />
* Right atrial and ventricular volume overload<br />
* Pulmonary artery dilation<br />
*'''Coronary sinus defect''': Enlarged ostium of the coronary sinus and unroofing of the terminal portion of the coronary sinus<br />
|<br />
* Systolic flow murmur in the pulmonary valve region<br />
*Wide, fixed splitting of S2<br />
*Diastolic flow rumble across the tricuspid valve<br />
*Right ventricular heave <br />
|<br />
* Spontaneous closure<br />
*Percutaneous transcatheter closure<br />
*Surgical closure<br />
|<br />
* Right sided heart failure<br />
* Peripheral edema<br />
* Eisenmenger syndrome (cyanosis)<br />
* Paradoxical emboli<br />
* Pulmonary hypertension<br />
|-<br />
|Pulmonary ateriovenous fistula<br />
|<br />
* Abnormal blood vessel(s) connecting the pulmonary arteries and veins directly without interposition of pulmonary capillaries<br />
|<br />
* Right-to-left shunt between the pulmonary artery and pulmonary vein<br />
|<br />
* Symptoms may occur only after the second decade<br />
*Cyanosis<br />
*Hemoptysis<br />
|<br />
* Chest CT<br />
*Pulmonary arteriogram<br />
|<br />
* Appearance of contrast bubbles in the left atrium three to five cardiac cycles after appearance in the right atrium<br />
|<br />
* Clubbing<br />
*Systolic/continuous murmur<br />
|<br />
* Embolization<br />
* Surgical resection<br />
|<br />
* Cerebral ischemia/abscess<br />
*Hemothorax<br />
|}<br />
<br />
==Differential table for aortic stenosis==<br />
<br />
{| class="wikitable"<br />
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;|Diseases<br />
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;|History<br />
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;|Symptoms<br />
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;|Physical Examination<br />
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;|Murmur<br />
! colspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;|Diagnosis<br />
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;|Other Findings<br />
|- style="background: #DCDCDC; padding: 5px; text-align: center;"<br />
!style="background: #4479BA; color: #FFFFFF; text-align: center;|ECG<br />
!style="background: #4479BA; color: #FFFFFF; text-align: center;|CXR<br />
!style="background: #4479BA; color: #FFFFFF; text-align: center;|Echocardiogram<br />
!style="background: #4479BA; color: #FFFFFF; text-align: center;|Cardiac Catheterization<br />
|-<br />
|style="background: #DCDCDC; padding: 5px; text-align: center;" |Aortic stenosis<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Age (aortic valve calcification)<br />
*Syncope<br />
*Orthopnea<br />
*Paroxysmal nocturnal dyspnea<br />
*Acute rheumatic fever<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Chest pain<br />
*Dyspnea on exertion<br />
*Palpitations<br />
*Symptoms of heart failure<br />
| style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Pulsus parvus et tardus<br />
*Pulmonary rales<br />
*Peripheral edema (In CHF patients)<br />
*Jugular venous distension<br />
*Enlarged and laterally displaced point of maximal impulse<br />
<br />
*<br />
| style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Crescendo-decrescendo systolic murmur<br />
*Best heard at the right upper sternal border<br />
*Radiation to the carotid arteries<br />
*Increases with squatting<br />
*Decreases with valsalva maneuver<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Left ventricular hypertrophy''':<br />
<br />
* Wide QRS complex (especially in leads V1-V6)<br />
*ST depression in leads V5-V6<br />
*Left axis deviation<br />
* <br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Enlarged left ventricle<br />
* Enlarged left atrium and pulmonary artery in severe cases<br />
*Calcification of the aortic valve<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Thickening and calcification of the aortic valve<br />
*Left ventricular hypertrophy<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Left heart catheterization:'''<br />
<br />
* Left ventricular and aortic pressures<br />
*The left ventricle generates higher pressures than what is transmitted to the aorta<br />
| style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Associated with von Willibrand disease<br />
|-<br />
| colspan="10" |<br />
|-<br />
|style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Mitral Stenosis]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Age ( Mitral annular calcification in older patients)<br />
<br />
* [[Rheumatic fever]]<br />
<br />
* [[Endocarditis]]<br />
<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* [[Dyspnea on exertion]]<br />
<br />
* [[Paroxysmal nocturnal dyspnea]]<br />
<br />
* [[Orthopnea]]<br />
<br />
* New onset [[atrial fibrillation]]<br />
<br />
| style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Mitral facies<br />
<br />
* Heart murmur<br />
<br />
* [[JVD|Jugular vein distension]]<br />
<br />
* Apical impulse displaced laterally or not palpable <br />
<br />
* Diastolic thrill at the apex <br />
<br />
* Signs of heart failure in severe cases<br />
| style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Diastolic murmur<br />
<br />
* Low pitched<br />
<br />
* Opening snap followed by decrescendo-crescendo rumbling murmur <br />
<br />
* Best heard with the bell of the stethoscope at apex at end-expiration in left lateral decubitus position <br />
<br />
* Intensity increases after a [[valsalva maneuver]], after exercise and after increased after load (eg., squatting, isometric hand grip) <br />
| style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* [[P mitrale]]<br />
* [[Atrial fibrillation]]: No P waves and irregularly irregular rhythm<br />
<br />
* [[Right axis deviation]]<br />
<br />
* Right ventricular hypertropy: Dominant R wave in V1 and V2<br />
| style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Straightening of the left border of the heart suggestive of enlargement of the [[left atrium]]<br />
<br />
* Double right heart border (Enlarged left atrium and normal right atrium) <br />
<br />
* Prominent left atrial appendage<br />
<br />
* Splaying of [[carina|subcarinal angle]] (>120 degrees)<br />
<br />
* Calcification of [[mitral valve]]<br />
<br />
* [[Kerley B lines]] <br />
<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Reduced valve leaflet mobility<br />
<br />
* Valve calcification <br />
<br />
* Doming of mitral valve<br />
<br />
* Valve thickening <br />
* Enlargement of left atrium <br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Right heart catheterization:'''<br />
* [[Pulmonary capillary wedge pressure]] (left atrial pressure) <br />
'''Left heart catheterization:'''<br />
* Pressures in left ventricle<br />
<br />
* Determines the gradient between the left and right atrium during ventricular diastole (marker of the severity of mitral stenosis)<br />
<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* [[Hemoptysis]] ([[heart failure]])<br />
<br />
* [[Ortner's syndrome]]<br />
|-<br />
| colspan="10" |<br />
|-<br />
|style="vertical-align: top;background: #DCDCDC; padding: 5px; text-align: center;" |[[Mitral Regurgitation]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* [[CAD]]<br />
<br />
* [[MI]]<br />
<br />
* [[Rheumatic fever]]<br />
<br />
* [[Endocarditis]]<br />
<br />
* [[Mitral valve prolapse]]<br />
<br />
* [[Cardiomyopathy]]<br />
<br />
* [[Radiation therapy]]<br />
<br />
* Trauma<br />
<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* [[Palpitations]]<br />
<br />
* Symptoms of heart failure in severe cases<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Palpation'''<br />
* Brisk carotid upstroke and hyperdymanic carotid impulse on palpation<br />
<br />
* Apical impulse is displaced to left<br />
<br />
* S3 and a palpable thrill<br />
'''Auscultation'''<br />
* Murmur<br />
<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* [[Holosystolic murmur]]<br />
<br />
* High pitched, blowing<br />
<br />
* Radiates to axilla<br />
<br />
* Best heard with the diaphragm of the stethoscope at apex in left lateral [[decubitus]] position<br />
<br />
* Intensity increases with hand grip or squatting <br />
<br />
* Decrease in intensity on standing or [[valsalva maneuver]] <br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* [[P mitrale]] in lead II<br />
* Increased QRS voltage<br />
* [[Right axis deviation]]<br />
* [[Atrial fibrillation]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Acute MR'''<br />
* [[Kerley B lines]]<br />
* No enlargement of cardiac silhouette<br />
'''Chronic MR'''<br />
* Enlarged cardiac silhouette<br />
* Straightening of left heart border<br />
* Splaying of subcarinal angle<br />
* Calcification of mitral annulus<br />
* Double right heart border<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Enlargement of left atrium and ventricle<br />
* Identify valve abnormality<br />
* Valve calcification<br />
* Severity of regurgitation<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Grading of MR is done with left ventriculography<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Decompensated and acute MR may lead to [[heart failure]]<br />
|-<br />
| colspan="10" |<br />
|-<br />
|style="vertical-align: top;background: #DCDCDC; padding: 5px; text-align: center;" |[[Atrial septal defect]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Frequent respiratory or lung infections<br />
* [[Dyspnea]]<br />
* Tiring when feeding (Infants)<br />
* Shortness of breath on exertion<br />
* [[Palpitations]]<br />
* Swelling of feet<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* [[Shortness of breath]]<br />
* [[Fatigue]]<br />
* [[Failure to thrive]]<br />
* Swelling of feet and abdomen ([[Right heart failure]])<br />
* [[Palpitations]]<br />
* Respiratory infections<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Inspection'''<br />
* Precordial bulge<br />
* Precordial lift<br />
'''Palpation'''<br />
* Right ventricular impulse<br />
* Pulmonary artery pulsations<br />
* Thrill<br />
'''Auscultation'''<br />
* Murmur<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Midsystolic (ejection systolic) murmur<br />
<br />
* Widely split, fixed S2<br />
<br />
* Upper left sternal border<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Normal <br />
* Prolonged PR interval<br />
* [[Right bundle branch block]]<br />
* ECG findings varies according to the underlying type of ASD<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
*Increased pulmonary markings<br />
*[[Cardiomegaly]]<br />
*Triangular appearance of heart<br />
*Schimitar sign<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Gold standard test for diagnosis of atrial septal defect (for more information click [[Atrial septal defect echocardiography]])<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Defect size<br />
* Pulmonary venous return<br />
* [[Pulmonary vascular resistance]]<br />
* [[Pulmonary artery hypertension]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Asymptomatic until later part of their life<br />
* May be associated with [[migraine with aura]]<br />
|-<br />
| colspan="10" |<br />
|-<br />
|style="vertical-align: top;background: #DCDCDC; padding: 5px; text-align: center;" |[[Atrial myxoma|Left Atrial Myxoma]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* [[Dyspnea]]<br />
* [[Orthopnea]]<br />
* [[Pulmonary edema]]<br />
* Hyperpigmentation of skin and endocrine activity<br />
* Cerebral [[embolism]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Symptoms may mimic mitral stenosis<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Skin'''<br />
* Signs of an embolic phenomenon<br />
* [[Raynaud's phenomenon]]<br />
* Swelling<br />
* Clubbing<br />
'''Auscultation:'''<br />
* Lung: Fine crepitations <br />
<br />
* Heart: Characteristic "tumor plop" <br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Early diastolic sound as "tumor plop"<br />
<br />
* Low frequency diastolic murmur may be heard if the tumor obstructing mitral valve <br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Often normal<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Often normal<br />
'''Rare findings:'''<br />
* [[cardiomegaly]]<br />
* Left atrial enlargement<br />
* tumor calcification etc.,<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Initial and most useful diagnostic study<br />
* For more information click [[Myxoma echocardiography or ultrasound]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Useful to detect vascular supply of the tumor by the coronary arteries <br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Associated with Carney complex (genetic predisposition)<br />
|-<br />
| colspan="10" |<br />
|-<br />
|style="vertical-align: top;background: #DCDCDC; padding: 5px; text-align: center;" |Prosthetic Valve Obstruction<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* History of valve replacement<br />
* Systemic embolism<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Shortness of breath<br />
* Fatigue<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Ausculation'''<br />
<br />
Muffling of murmur<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Muffling or disappearance of prosthetic sounds<br />
<br />
* Appearance of new regurgitant or obstructive murmur <br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Degree of stenosis<br />
* Assess thrombus size and location<br />
* Differentiate between thrombus, [[pannus]] and vegetations<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |Causes:<br />
* Thrombus<br />
* Pannus formation<br />
|-<br />
| colspan="10" |<br />
|-<br />
|style="vertical-align: top;background: #DCDCDC; padding: 5px; text-align: center;" |[[Cor Triatriatum]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Dyspnea on exertion <br />
* Recent onset of [[congestive heart failure]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Dsypnea on exertion<br />
* Orthopnea<br />
* Tachypnea<br />
* Palpitations<br />
* Growth failure<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Auscultation'''<br />
* Murmur<br />
'''Other findings'''<br />
* Signs of heart failure<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Diastolic murmur with loud P2<br />
<br />
* No opening snap or a loud S1<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |Non specific but may have<br />
* [[Right axis deviation]]<br />
* Right atrial enlargement<br />
* [[Right ventricular hypertrophy]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Normal cardiac silhouette<br />
* Hemodynamic changes similar to mitral stenosis (non specific findings)<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Direct visualization of membrane through the atrium<br />
* +/- visualization of accessory chamber<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Normal left ventricular hemodynamic profile with a trans atrial gradient<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |Types<br />
* Cor triatriatum sinistrum<br />
* Cor triatriatum dextrum<br />
|-<br />
| colspan="10" |<br />
|-<br />
|style="vertical-align: top;background: #DCDCDC; padding: 5px; text-align: center;" |Congenital Mitral Stenosis<br />
| style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Respiratory distress shortly after birth<br />
* Recurrent severe pulmonary infections<br />
* Other associated congenital cardiovascular anamolies<br />
* [[Atrial fibrillation]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
<br />
'''Infants:'''<br />
* Exhaustion and sweating on feeding<br />
* Rapid breathing<br />
* [[Failure to thrive]]<br />
* Pulmonary infections <br />
* Chronic cough<br />
'''Older patients:'''<br />
* Dyspnea<br />
* Orthopnea<br />
* Paroxysmal nocturnal dyspnea<br />
* Peripheral edema<br />
* Fatigue<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Auscultation'''<br />
* Murmur<br />
'''Other findings'''<br />
* Signs of heart failure<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Mild-Moderate'''<br />
* Loud S1<br />
<br />
* Loud P2<br />
<br />
* Low frequency diastolic murmur best heard at the apex <br />
'''Severe'''<br />
* Soft S1<br />
<br />
* Loud pulmonic component of S2 with minimal respiratory splitting of S2 <br />
<br />
* Holodiastolic murmur with presystolic accentuation best heard at the apex <br />
<br />
* Early diastolic murmur of pulmonic valve regurgitation <br />
<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
*Sharp P waves in leads I and II<br />
*Inversion of P wave in lead III<br />
*Marked Q waves in leads II and III<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Left atrial dilation<br />
* Moderate enlargement of right heart<br />
* Pulmonary venous congestion<br />
* Esophageal compression<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Reduced valve leaflet mobility<br />
* Left atrial size<br />
* Severity of mitral stenosis<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |Very rare condition<br />
|-<br />
| colspan="10" |<br />
|-<br />
|style="vertical-align: top;background: #DCDCDC; padding: 5px; text-align: center;" |Supravalvular Ring Mitral Stenosis<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Other associated congenital heart defects<br />
* Fatigue<br />
* Frequent respiratory infections<br />
* Failure to thrive<br />
* Poor feeding<br />
* Precocious congestive heart failure <br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Shortness of breath<br />
<br />
* Tachypnea<br />
* Dyspnea<br />
* Nocturnal cough<br />
* Heamoptysis<br />
* [[Syncope]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Auscultation:'''<br />
<br />
Lungs: Fine, crepitant rales and rhonchi or wheezes may be present<br />
<br />
Heart: Murmur<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* An apical mid diastolic murmur with presystolic accentuation<br />
<br />
* No opening snap<br />
<br />
* The murmur is more prominent if associated with [[VSD]] or [[PDA]]<br />
<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Left atrial and ventricular enlargement<br />
* Alveolar edema <br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Supramitral ring''':<br />
* Associated with normal mitral valve apparatus<br />
'''Intramitral ring:'''<br />
* Hypomobility of the posterior leaflet<br />
* Reduced interpapillary muscle distance<br />
* Reduced chordal length<br />
* Dominant papillary muscle<br />
* Hypoplastic mitral annulus<br />
(Difficult to visualize membrane <1mm in size)<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Persistently elevated pulmonary venous pressures<br />
* Increased pulmonary artery pressure<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Types'''<br />
* Supramitral<br />
* Intramitral<br />
It is attached between the opening of the atrial appendage and the mitral annulus which helps in differentiating with Cor triatriatum sinister.<br />
* Intramitral type is associated with shone complex<br />
|}</div>
Ifeoma odukwe
https://www.wikidoc.org/index.php?title=Sandbox:_Ifeoma&diff=1608421
Sandbox: Ifeoma
2020-05-16T15:37:22Z
<p>Ifeoma odukwe: /* Pathophysiology */</p>
<hr />
<div>Wikidoc practice session<br />
<br />
==Pathophysiology==<br />
===Physiology===<br />
<br />
==Classification of dextrocardia==<br />
{| style="border: 0px; font-size: 90%; margin: 3px; width: 1000px"<br />
|valign=top|<br />
|+<br />
! style="background: #4479BA; width: 250px; color: #FFFFFF;"|'''Dextrocardia Types'''<br />
<br />
! style="background: #4479BA; width: 600px; color: #FFFFFF;"|'''Description'''<br />
<br />
|-<br />
<br />
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align=center | '''Dextrocardia with situs solitus '''|| style="padding: 5px 5px; background: #F5F5F5;" |<br />
:* Dextrocardia with normally related great arteries and D-transposition (complete transposition) or L-transposition (congenitally corrected transposition) of the great arteries. Some examples include dextrocardia with D-loop ventricles and normally related great arteries, with L-loop ventricles and L-TGA (congenitally corrected TGA).<br />
:* Embryologic failure of the final leftward shift of the ventricles during development results in dextrocardia with situs solitus, D-loop ventricles, and normally related great arteries.<br />
<br />
|-<br />
<br />
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align=center | '''Dextrocardia with situs inversus '''|| style="padding: 5px 5px; background: #F5F5F5;"|<br />
:* May present with dextrocardia with inversely related great arteries and D-transposition (congenitally corrected transposition) or L-transposition (“uncorrected” transposition) of the great arteries. An example is dextrocardia with D-loop ventricles and D-TGA (congenitally corrected TGA).<br />
<br />
|-<br />
<br />
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align=center | '''Dextrocardia with situs ambiguous (either polyspenia or asplenia)''' || style="padding: 5px 5px; background: #F5F5F5;"|<br />
:* Dextrocardia with any of the above relationships between the ventricles and great vessels.<br />
<br />
|-<br />
<br />
<br />
{|<br />
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"<br />
! rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;|Diseases<br />
| colspan="6" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;|'''Clinical manifestations'''<br />
! colspan="3" rowspan="2" |Para-clinical findings<br />
| colspan="1" rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;|'''Gold standard'''<br />
! rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;|Additional findings<br />
|-<br />
| colspan="3" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;|'''Symptoms'''<br />
! colspan="3" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;|Physical examination<br />
|-<br />
! colspan="3" style="background: #4479BA; color: #FFFFFF; text-align: center;|Imaging<br />
|- <br />
! style="background: #4479BA; color: #FFFFFF; text-align: center;|Exertional dyspnea<br />
! colspan="1" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;|Failure to thrive<br />
! style="background: #4479BA; color: #FFFFFF; text-align: center;|Recurrent respiratory infections<br />
! style="background: #4479BA; color: #FFFFFF; text-align: center;|Murmur on auscultation<br />
! colspan="1" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;|Peripheral edema<br />
! style="background: #4479BA; color: #FFFFFF; text-align: center;|Clubbing<br />
! style="background: #4479BA; color: #FFFFFF; text-align: center;|Echocardiography<br />
! style="background: #4479BA; color: #FFFFFF; text-align: center;|Chest x-ray<br />
! style="background: #4479BA; color: #FFFFFF; text-align: center;|Cardiac CT<br />
|-<br />
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Patent foramen ovale]]<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Appearance of at least 3 micro-bubbles in the left atrium within three cardiac cycles after complete opacification of the right atrium<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | Non specific<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | <br />
* A contrast agent jet from the left atrium to the right atrium toward the inferior vena cava with channel-like appearance of the interatrial septum<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Echocardiogram<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* It is associated with paradoxical embolism, migraine headache, and decompression sickness in divers<br />
|-<br />
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Atrial septal defect]]<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/−<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/−<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/− <br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Systolic flow murmur in the upper left sternal border<br />
* Wide, fixed splitting of S2<br />
* Diastolic flow rumble across the tricuspid valve<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/−<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/−<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Hypermobile interatrial septum<br />
* Abrupt septal irregularity<br />
* Right atrial and ventricular volume overload<br />
* Pulmonary artery dilatation<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Cardiomegaly <br />
* Pulmonary artery enlargement/increased pulmonary vascularity<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Enlargement of the right atrium and ventricle<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Echocardiogram<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Atrial septal defect is classified into 5 types including ostium primum defect, ostium secundum defect, superior sinus venosus defect, inferior sinus venosus defect, and coronary sinus defect<br />
|-<br />
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Ventricular septal defect]]<br />
| style="background: #F5F5F5; padding: 5px;" |-/+<br />
| style="background: #F5F5F5; padding: 5px;" |-/+<br />
| style="background: #F5F5F5; padding: 5px;" |After Eisenmenger syndrome<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Holosystolic murmur<br />
* May mimic aortic stenosis(mid/end dyastolic murmur due to increased pulmonary circulation)<br />
| style="background: #F5F5F5; padding: 5px;" |-/+<br />
| style="background: #F5F5F5; padding: 5px;" |-/+<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Defect localization<br />
*septal dropout in the area adjacent to the tricuspid septal leaflet and below the right border of the aortic annulus<br />
* Direction of jet<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* [[Cardiomegaly]] in large VSD<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Direct visualisation of murmur<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Echocardiogram<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"<br />
!Diseases<br />
!Exertional dyspnea<br />
! colspan="1" rowspan="1" |Failure to thrive<br />
!Recurrent respiratory infections<br />
!Murmur on auscultation<br />
! colspan="1" rowspan="1" |Peripheral edema<br />
!Clubbing<br />
!Echocardiography<br />
!Chest x-ray<br />
!Cardiac CT<br />
|'''Gold standard'''<br />
!Additional findings<br />
|-<br />
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Patent ductus arteriosus]]<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Not at beginning<br />
* May be produced during the course of disease <br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Depends on the size<br />
| style="background: #F5F5F5; padding: 5px;" | -<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Continuous machine-like murmur<br />
| style="background: #F5F5F5; padding: 5px;" |-<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* May be present by progressing<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Golden standard <br />
* In color-Doppler visualization of flow through the patent duct which has a high velocity<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Non-specific<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Used for determining Krichenko classification<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Echocardiogram<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Krichenko criteria for classification is a very important factor for treatment<br />
|-<br />
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Aortic coarctation|Coarctation of the aorta]]<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/−<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/−<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Systolic murmur over the upper sternal border with radiation to the back<br />
*Murmur of mitral regurgitation (holosystolic murmur best heard at the apex)<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Narrowing of the aortic arch at the level of the isthmus<br />
* Left ventricular hypertrophy<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Notching of the posterior fourth to eighth ribs due to dilated intercostal arteries<br />
* Indentation of the aorta at the site of coarctation with pre- and post-stenotic dilation of the aorta (classic "3 sign")<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Dilation of the intercostal arteries<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Echocardiogram<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
*Patients present with arm-leg blood pressure gradient of >20mmHg<br />
|-<br />
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Aortic stenosis]]<br />
| style="background: #F5F5F5; padding: 5px;" |+<br />
| style="background: #F5F5F5; padding: 5px;" |+<br />
| style="background: #F5F5F5; padding: 5px;" |+<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Crescendo-decrescendo mid-systolic (or ejection systolic) murmur<br />
| style="background: #F5F5F5; padding: 5px;" |+/-<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Depending on severity<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Used for finding the location of stenosis<br />
* Finding severity<br />
* Evaluating the flow jet with color-Doppler ultrasound technique<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Non-specific at the beginning<br />
* At progressed stage calcification of the valve and cardiomegally<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
*[[Aortic calcification|Calcification score]]<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* MRI<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* MRI provides a more detailed structural and dynamic assessment of the aortic valve and left ventricle, in particular<br />
|-<br />
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Pulmonary valve stenosis|Pulmonary stenosis]]<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Depending on severity<br />
| style="background: #F5F5F5; padding: 5px;" | -<br />
| style="background: #F5F5F5; padding: 5px;" | -/+<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Continuous systolic murmur<br />
| style="background: #F5F5F5; padding: 5px;" |-<br />
| style="background: #F5F5F5; padding: 5px;" | -/+<br />
| style="background: #F5F5F5; padding: 5px;" | <br />
* Right atrial hypertrophy<br />
| style="background: #F5F5F5; padding: 5px;" | <br />
* Non-specific<br />
| style="background: #F5F5F5; padding: 5px;" | <br />
* Direct visualization of stenosis<br />
| style="background: #F5F5F5; padding: 5px;" | <br />
* Echocardiogram<br />
| style="background: #F5F5F5; padding: 5px;" | <br />
|}<br />
<br />
<br />
<br />
<br />
<br />
<br />
<br />
<br />
<br />
<br />
<br />
{| class="wikitable"<br />
|+<br />
!Diseases<br />
!Pathophysiology<br />
!Shunt<br />
!Symptoms<br />
!Diagnosis<br />
!Echocardiography findings<br />
!Physical examination<br />
!Treatment<br />
!Complications<br />
|-<br />
|Patent foramen ovale<br />
|<br />
* Failure of fusion of the septum primum and septum secundum leading to a flap valve opening.<br />
|<br />
* Right-to-left shunt<br />
<br />
* More prominent with increased right atrial pressure.<br />
|<br />
* Majority of patients are asymptomatic<br />
|<br />
* TEE (Gold standard)<br />
<br />
* TTE<br />
<br />
* TCD<br />
|<br />
* Appearance of at least 3 micro-bubbles in the left atrium within three cardiac cycles after the complete opacification of the right atrium<br />
|<br />
|<br />
* Percutaneous closure<br />
* Anticoagulants<br />
* Antiplatelets<br />
|<br />
* Paradoxical embolism<br />
<br />
* Migraine with aura<br />
*Decompression sickness in divers<br />
*Platypnea-orthodeoxia syndrome<br /><br />
|-<br />
|Atrial septal defect<br />
|<br />
* '''Ostium secundum defect''': Failure of the septum secundum to occlude the ostium secundum.<br />
<br />
* '''Ostium primum defect''': Failure of the ostium primum to fuse with the endocardial cushions.<br />
<br />
* '''Superior sinus venosus defect''': The orifice of the superior vena cava overrides the atrial septum above the fossa ovalis.<br />
<br />
* '''Inferior sinus venosus defect''': The orifice of the inferior vena cava overrides the left and right atrium.<br />
*'''Coronary sinus defect''': Absence of a portion of the common wall that separates the coronary sinus and the left atrium.<br />
|<br />
* Continuous left-to-right shunt<br />
|<br />
* Failure to thrive, tachypnea, recurrent respiratory infections, heart failure<br />
<br />
* Commonly asymptomatic during childhood and adolescence<br />
*Adults with large shunts may become symptomatic in the fourth decade presenting with fatigue, exercise intolerance, palpitations, syncope, and shortness of breath.<br />
<br />
*<br />
|<br />
* TTE (Gold standard)<br />
*Cardiac CT<br />
*Cardiac MRI<br />
|<br />
* Hypermobile interatrial septum<br />
* Abrupt septal irregularity<br />
* Right atrial and ventricular volume overload<br />
* Pulmonary artery dilation<br />
*'''Coronary sinus defect''': Enlarged ostium of the coronary sinus and unroofing of the terminal portion of the coronary sinus<br />
|<br />
* Systolic flow murmur in the pulmonary valve region<br />
*Wide, fixed splitting of S2<br />
*Diastolic flow rumble across the tricuspid valve<br />
*Right ventricular heave <br />
|<br />
* Spontaneous closure<br />
*Percutaneous transcatheter closure<br />
*Surgical closure<br />
|<br />
* Right sided heart failure<br />
* Peripheral edema<br />
* Eisenmenger syndrome (cyanosis)<br />
* Paradoxical emboli<br />
* Pulmonary hypertension<br />
|-<br />
|Pulmonary ateriovenous fistula<br />
|<br />
* Abnormal blood vessel(s) connecting the pulmonary arteries and veins directly without interposition of pulmonary capillaries<br />
|<br />
* Right-to-left shunt between the pulmonary artery and pulmonary vein<br />
|<br />
* Symptoms may occur only after the second decade<br />
*Cyanosis<br />
*Hemoptysis<br />
|<br />
* Chest CT<br />
*Pulmonary arteriogram<br />
|<br />
* Appearance of contrast bubbles in the left atrium three to five cardiac cycles after appearance in the right atrium<br />
|<br />
* Clubbing<br />
*Systolic/continuous murmur<br />
|<br />
* Embolization<br />
* Surgical resection<br />
|<br />
* Cerebral ischemia/abscess<br />
*Hemothorax<br />
|}<br />
<br />
==Differential table for aortic stenosis==<br />
<br />
{| class="wikitable"<br />
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;|Diseases<br />
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;|History<br />
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;|Symptoms<br />
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;|Physical Examination<br />
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;|Murmur<br />
! colspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;|Diagnosis<br />
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;|Other Findings<br />
|- style="background: #DCDCDC; padding: 5px; text-align: center;"<br />
!style="background: #4479BA; color: #FFFFFF; text-align: center;|ECG<br />
!style="background: #4479BA; color: #FFFFFF; text-align: center;|CXR<br />
!style="background: #4479BA; color: #FFFFFF; text-align: center;|Echocardiogram<br />
!style="background: #4479BA; color: #FFFFFF; text-align: center;|Cardiac Catheterization<br />
|-<br />
|style="background: #DCDCDC; padding: 5px; text-align: center;" |Aortic stenosis<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Age (aortic valve calcification)<br />
*Syncope<br />
*Orthopnea<br />
*Paroxysmal nocturnal dyspnea<br />
*Acute rheumatic fever<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Chest pain<br />
*Dyspnea on exertion<br />
*Palpitations<br />
*Symptoms of heart failure<br />
| style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Pulsus parvus et tardus<br />
*Pulmonary rales<br />
*Peripheral edema (In CHF patients)<br />
*Jugular venous distension<br />
*Enlarged and laterally displaced point of maximal impulse<br />
<br />
*<br />
| style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Crescendo-decrescendo systolic murmur<br />
*Best heard at the right upper sternal border<br />
*Radiation to the carotid arteries<br />
*Increases with squatting<br />
*Decreases with valsalva maneuver<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Left ventricular hypertrophy''':<br />
<br />
* Wide QRS complex (especially in leads V1-V6)<br />
*ST depression in leads V5-V6<br />
*Left axis deviation<br />
* <br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Enlarged left ventricle<br />
* Enlarged left atrium and pulmonary artery in severe cases<br />
*Calcification of the aortic valve<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Thickening and calcification of the aortic valve<br />
*Left ventricular hypertrophy<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Left heart catheterization:'''<br />
<br />
* Left ventricular and aortic pressures<br />
*The left ventricle generates higher pressures than what is transmitted to the aorta<br />
| style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Associated with von Willibrand disease<br />
|-<br />
| colspan="10" |<br />
|-<br />
|style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Mitral Stenosis]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Age ( Mitral annular calcification in older patients)<br />
<br />
* [[Rheumatic fever]]<br />
<br />
* [[Endocarditis]]<br />
<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* [[Dyspnea on exertion]]<br />
<br />
* [[Paroxysmal nocturnal dyspnea]]<br />
<br />
* [[Orthopnea]]<br />
<br />
* New onset [[atrial fibrillation]]<br />
<br />
| style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Mitral facies<br />
<br />
* Heart murmur<br />
<br />
* [[JVD|Jugular vein distension]]<br />
<br />
* Apical impulse displaced laterally or not palpable <br />
<br />
* Diastolic thrill at the apex <br />
<br />
* Signs of heart failure in severe cases<br />
| style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Diastolic murmur<br />
<br />
* Low pitched<br />
<br />
* Opening snap followed by decrescendo-crescendo rumbling murmur <br />
<br />
* Best heard with the bell of the stethoscope at apex at end-expiration in left lateral decubitus position <br />
<br />
* Intensity increases after a [[valsalva maneuver]], after exercise and after increased after load (eg., squatting, isometric hand grip) <br />
| style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* [[P mitrale]]<br />
* [[Atrial fibrillation]]: No P waves and irregularly irregular rhythm<br />
<br />
* [[Right axis deviation]]<br />
<br />
* Right ventricular hypertropy: Dominant R wave in V1 and V2<br />
| style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Straightening of the left border of the heart suggestive of enlargement of the [[left atrium]]<br />
<br />
* Double right heart border (Enlarged left atrium and normal right atrium) <br />
<br />
* Prominent left atrial appendage<br />
<br />
* Splaying of [[carina|subcarinal angle]] (>120 degrees)<br />
<br />
* Calcification of [[mitral valve]]<br />
<br />
* [[Kerley B lines]] <br />
<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Reduced valve leaflet mobility<br />
<br />
* Valve calcification <br />
<br />
* Doming of mitral valve<br />
<br />
* Valve thickening <br />
* Enlargement of left atrium <br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Right heart catheterization:'''<br />
* [[Pulmonary capillary wedge pressure]] (left atrial pressure) <br />
'''Left heart catheterization:'''<br />
* Pressures in left ventricle<br />
<br />
* Determines the gradient between the left and right atrium during ventricular diastole (marker of the severity of mitral stenosis)<br />
<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* [[Hemoptysis]] ([[heart failure]])<br />
<br />
* [[Ortner's syndrome]]<br />
|-<br />
| colspan="10" |<br />
|-<br />
|style="vertical-align: top;background: #DCDCDC; padding: 5px; text-align: center;" |[[Mitral Regurgitation]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* [[CAD]]<br />
<br />
* [[MI]]<br />
<br />
* [[Rheumatic fever]]<br />
<br />
* [[Endocarditis]]<br />
<br />
* [[Mitral valve prolapse]]<br />
<br />
* [[Cardiomyopathy]]<br />
<br />
* [[Radiation therapy]]<br />
<br />
* Trauma<br />
<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* [[Palpitations]]<br />
<br />
* Symptoms of heart failure in severe cases<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Palpation'''<br />
* Brisk carotid upstroke and hyperdymanic carotid impulse on palpation<br />
<br />
* Apical impulse is displaced to left<br />
<br />
* S3 and a palpable thrill<br />
'''Auscultation'''<br />
* Murmur<br />
<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* [[Holosystolic murmur]]<br />
<br />
* High pitched, blowing<br />
<br />
* Radiates to axilla<br />
<br />
* Best heard with the diaphragm of the stethoscope at apex in left lateral [[decubitus]] position<br />
<br />
* Intensity increases with hand grip or squatting <br />
<br />
* Decrease in intensity on standing or [[valsalva maneuver]] <br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* [[P mitrale]] in lead II<br />
* Increased QRS voltage<br />
* [[Right axis deviation]]<br />
* [[Atrial fibrillation]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Acute MR'''<br />
* [[Kerley B lines]]<br />
* No enlargement of cardiac silhouette<br />
'''Chronic MR'''<br />
* Enlarged cardiac silhouette<br />
* Straightening of left heart border<br />
* Splaying of subcarinal angle<br />
* Calcification of mitral annulus<br />
* Double right heart border<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Enlargement of left atrium and ventricle<br />
* Identify valve abnormality<br />
* Valve calcification<br />
* Severity of regurgitation<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Grading of MR is done with left ventriculography<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Decompensated and acute MR may lead to [[heart failure]]<br />
|-<br />
| colspan="10" |<br />
|-<br />
|style="vertical-align: top;background: #DCDCDC; padding: 5px; text-align: center;" |[[Atrial septal defect]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Frequent respiratory or lung infections<br />
* [[Dyspnea]]<br />
* Tiring when feeding (Infants)<br />
* Shortness of breath on exertion<br />
* [[Palpitations]]<br />
* Swelling of feet<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* [[Shortness of breath]]<br />
* [[Fatigue]]<br />
* [[Failure to thrive]]<br />
* Swelling of feet and abdomen ([[Right heart failure]])<br />
* [[Palpitations]]<br />
* Respiratory infections<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Inspection'''<br />
* Precordial bulge<br />
* Precordial lift<br />
'''Palpation'''<br />
* Right ventricular impulse<br />
* Pulmonary artery pulsations<br />
* Thrill<br />
'''Auscultation'''<br />
* Murmur<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Midsystolic (ejection systolic) murmur<br />
<br />
* Widely split, fixed S2<br />
<br />
* Upper left sternal border<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Normal <br />
* Prolonged PR interval<br />
* [[Right bundle branch block]]<br />
* ECG findings varies according to the underlying type of ASD<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
*Increased pulmonary markings<br />
*[[Cardiomegaly]]<br />
*Triangular appearance of heart<br />
*Schimitar sign<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Gold standard test for diagnosis of atrial septal defect (for more information click [[Atrial septal defect echocardiography]])<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Defect size<br />
* Pulmonary venous return<br />
* [[Pulmonary vascular resistance]]<br />
* [[Pulmonary artery hypertension]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Asymptomatic until later part of their life<br />
* May be associated with [[migraine with aura]]<br />
|-<br />
| colspan="10" |<br />
|-<br />
|style="vertical-align: top;background: #DCDCDC; padding: 5px; text-align: center;" |[[Atrial myxoma|Left Atrial Myxoma]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* [[Dyspnea]]<br />
* [[Orthopnea]]<br />
* [[Pulmonary edema]]<br />
* Hyperpigmentation of skin and endocrine activity<br />
* Cerebral [[embolism]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Symptoms may mimic mitral stenosis<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Skin'''<br />
* Signs of an embolic phenomenon<br />
* [[Raynaud's phenomenon]]<br />
* Swelling<br />
* Clubbing<br />
'''Auscultation:'''<br />
* Lung: Fine crepitations <br />
<br />
* Heart: Characteristic "tumor plop" <br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Early diastolic sound as "tumor plop"<br />
<br />
* Low frequency diastolic murmur may be heard if the tumor obstructing mitral valve <br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Often normal<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Often normal<br />
'''Rare findings:'''<br />
* [[cardiomegaly]]<br />
* Left atrial enlargement<br />
* tumor calcification etc.,<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Initial and most useful diagnostic study<br />
* For more information click [[Myxoma echocardiography or ultrasound]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Useful to detect vascular supply of the tumor by the coronary arteries <br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Associated with Carney complex (genetic predisposition)<br />
|-<br />
| colspan="10" |<br />
|-<br />
|style="vertical-align: top;background: #DCDCDC; padding: 5px; text-align: center;" |Prosthetic Valve Obstruction<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* History of valve replacement<br />
* Systemic embolism<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Shortness of breath<br />
* Fatigue<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Ausculation'''<br />
<br />
Muffling of murmur<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Muffling or disappearance of prosthetic sounds<br />
<br />
* Appearance of new regurgitant or obstructive murmur <br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Degree of stenosis<br />
* Assess thrombus size and location<br />
* Differentiate between thrombus, [[pannus]] and vegetations<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |Causes:<br />
* Thrombus<br />
* Pannus formation<br />
|-<br />
| colspan="10" |<br />
|-<br />
|style="vertical-align: top;background: #DCDCDC; padding: 5px; text-align: center;" |[[Cor Triatriatum]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Dyspnea on exertion <br />
* Recent onset of [[congestive heart failure]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Dsypnea on exertion<br />
* Orthopnea<br />
* Tachypnea<br />
* Palpitations<br />
* Growth failure<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Auscultation'''<br />
* Murmur<br />
'''Other findings'''<br />
* Signs of heart failure<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Diastolic murmur with loud P2<br />
<br />
* No opening snap or a loud S1<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |Non specific but may have<br />
* [[Right axis deviation]]<br />
* Right atrial enlargement<br />
* [[Right ventricular hypertrophy]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Normal cardiac silhouette<br />
* Hemodynamic changes similar to mitral stenosis (non specific findings)<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Direct visualization of membrane through the atrium<br />
* +/- visualization of accessory chamber<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Normal left ventricular hemodynamic profile with a trans atrial gradient<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |Types<br />
* Cor triatriatum sinistrum<br />
* Cor triatriatum dextrum<br />
|-<br />
| colspan="10" |<br />
|-<br />
|style="vertical-align: top;background: #DCDCDC; padding: 5px; text-align: center;" |Congenital Mitral Stenosis<br />
| style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Respiratory distress shortly after birth<br />
* Recurrent severe pulmonary infections<br />
* Other associated congenital cardiovascular anamolies<br />
* [[Atrial fibrillation]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
<br />
'''Infants:'''<br />
* Exhaustion and sweating on feeding<br />
* Rapid breathing<br />
* [[Failure to thrive]]<br />
* Pulmonary infections <br />
* Chronic cough<br />
'''Older patients:'''<br />
* Dyspnea<br />
* Orthopnea<br />
* Paroxysmal nocturnal dyspnea<br />
* Peripheral edema<br />
* Fatigue<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Auscultation'''<br />
* Murmur<br />
'''Other findings'''<br />
* Signs of heart failure<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Mild-Moderate'''<br />
* Loud S1<br />
<br />
* Loud P2<br />
<br />
* Low frequency diastolic murmur best heard at the apex <br />
'''Severe'''<br />
* Soft S1<br />
<br />
* Loud pulmonic component of S2 with minimal respiratory splitting of S2 <br />
<br />
* Holodiastolic murmur with presystolic accentuation best heard at the apex <br />
<br />
* Early diastolic murmur of pulmonic valve regurgitation <br />
<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
*Sharp P waves in leads I and II<br />
*Inversion of P wave in lead III<br />
*Marked Q waves in leads II and III<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Left atrial dilation<br />
* Moderate enlargement of right heart<br />
* Pulmonary venous congestion<br />
* Esophageal compression<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Reduced valve leaflet mobility<br />
* Left atrial size<br />
* Severity of mitral stenosis<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |Very rare condition<br />
|-<br />
| colspan="10" |<br />
|-<br />
|style="vertical-align: top;background: #DCDCDC; padding: 5px; text-align: center;" |Supravalvular Ring Mitral Stenosis<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Other associated congenital heart defects<br />
* Fatigue<br />
* Frequent respiratory infections<br />
* Failure to thrive<br />
* Poor feeding<br />
* Precocious congestive heart failure <br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Shortness of breath<br />
<br />
* Tachypnea<br />
* Dyspnea<br />
* Nocturnal cough<br />
* Heamoptysis<br />
* [[Syncope]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Auscultation:'''<br />
<br />
Lungs: Fine, crepitant rales and rhonchi or wheezes may be present<br />
<br />
Heart: Murmur<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* An apical mid diastolic murmur with presystolic accentuation<br />
<br />
* No opening snap<br />
<br />
* The murmur is more prominent if associated with [[VSD]] or [[PDA]]<br />
<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Left atrial and ventricular enlargement<br />
* Alveolar edema <br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Supramitral ring''':<br />
* Associated with normal mitral valve apparatus<br />
'''Intramitral ring:'''<br />
* Hypomobility of the posterior leaflet<br />
* Reduced interpapillary muscle distance<br />
* Reduced chordal length<br />
* Dominant papillary muscle<br />
* Hypoplastic mitral annulus<br />
(Difficult to visualize membrane <1mm in size)<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Persistently elevated pulmonary venous pressures<br />
* Increased pulmonary artery pressure<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Types'''<br />
* Supramitral<br />
* Intramitral<br />
It is attached between the opening of the atrial appendage and the mitral annulus which helps in differentiating with Cor triatriatum sinister.<br />
* Intramitral type is associated with shone complex<br />
|}</div>
Ifeoma odukwe
https://www.wikidoc.org/index.php?title=Sandbox:_Ifeoma&diff=1608420
Sandbox: Ifeoma
2020-05-16T15:36:03Z
<p>Ifeoma odukwe: </p>
<hr />
<div>Wikidoc practice session<br />
<br />
==Pathophysiology==<br />
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==Classification of dextrocardia==<br />
{| style="border: 0px; font-size: 90%; margin: 3px; width: 1000px"<br />
|valign=top|<br />
|+<br />
! style="background: #4479BA; width: 250px; color: #FFFFFF;"|'''Dextrocardia Types'''<br />
<br />
! style="background: #4479BA; width: 600px; color: #FFFFFF;"|'''Description'''<br />
<br />
|-<br />
<br />
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align=center | '''Dextrocardia with situs solitus '''|| style="padding: 5px 5px; background: #F5F5F5;" |<br />
:* Dextrocardia with normally related great arteries and D-transposition (complete transposition) or L-transposition (congenitally corrected transposition) of the great arteries. Some examples include dextrocardia with D-loop ventricles and normally related great arteries, with L-loop ventricles and L-TGA (congenitally corrected TGA).<br />
:* Embryologic failure of the final leftward shift of the ventricles during development results in dextrocardia with situs solitus, D-loop ventricles, and normally related great arteries.<br />
<br />
|-<br />
<br />
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align=center | '''Dextrocardia with situs inversus '''|| style="padding: 5px 5px; background: #F5F5F5;"|<br />
:* May present with dextrocardia with inversely related great arteries and D-transposition (congenitally corrected transposition) or L-transposition (“uncorrected” transposition) of the great arteries. An example is dextrocardia with D-loop ventricles and D-TGA (congenitally corrected TGA).<br />
<br />
|-<br />
<br />
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align=center | '''Dextrocardia with situs ambiguous (either polyspenia or asplenia)''' || style="padding: 5px 5px; background: #F5F5F5;"|<br />
:* Dextrocardia with any of the above relationships between the ventricles and great vessels.<br />
<br />
|-<br />
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<br />
{|<br />
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"<br />
! rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;|Diseases<br />
| colspan="6" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;|'''Clinical manifestations'''<br />
! colspan="3" rowspan="2" |Para-clinical findings<br />
| colspan="1" rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;|'''Gold standard'''<br />
! rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;|Additional findings<br />
|-<br />
| colspan="3" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;|'''Symptoms'''<br />
! colspan="3" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;|Physical examination<br />
|-<br />
! colspan="3" style="background: #4479BA; color: #FFFFFF; text-align: center;|Imaging<br />
|- <br />
! style="background: #4479BA; color: #FFFFFF; text-align: center;|Exertional dyspnea<br />
! colspan="1" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;|Failure to thrive<br />
! style="background: #4479BA; color: #FFFFFF; text-align: center;|Recurrent respiratory infections<br />
! style="background: #4479BA; color: #FFFFFF; text-align: center;|Murmur on auscultation<br />
! colspan="1" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;|Peripheral edema<br />
! style="background: #4479BA; color: #FFFFFF; text-align: center;|Clubbing<br />
! style="background: #4479BA; color: #FFFFFF; text-align: center;|Echocardiography<br />
! style="background: #4479BA; color: #FFFFFF; text-align: center;|Chest x-ray<br />
! style="background: #4479BA; color: #FFFFFF; text-align: center;|Cardiac CT<br />
|-<br />
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Patent foramen ovale]]<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Appearance of at least 3 micro-bubbles in the left atrium within three cardiac cycles after complete opacification of the right atrium<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | Non specific<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | <br />
* A contrast agent jet from the left atrium to the right atrium toward the inferior vena cava with channel-like appearance of the interatrial septum<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Echocardiogram<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* It is associated with paradoxical embolism, migraine headache, and decompression sickness in divers<br />
|-<br />
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Atrial septal defect]]<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/−<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/−<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/− <br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Systolic flow murmur in the upper left sternal border<br />
* Wide, fixed splitting of S2<br />
* Diastolic flow rumble across the tricuspid valve<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/−<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/−<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Hypermobile interatrial septum<br />
* Abrupt septal irregularity<br />
* Right atrial and ventricular volume overload<br />
* Pulmonary artery dilatation<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Cardiomegaly <br />
* Pulmonary artery enlargement/increased pulmonary vascularity<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Enlargement of the right atrium and ventricle<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Echocardiogram<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Atrial septal defect is classified into 5 types including ostium primum defect, ostium secundum defect, superior sinus venosus defect, inferior sinus venosus defect, and coronary sinus defect<br />
|-<br />
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Ventricular septal defect]]<br />
| style="background: #F5F5F5; padding: 5px;" |-/+<br />
| style="background: #F5F5F5; padding: 5px;" |-/+<br />
| style="background: #F5F5F5; padding: 5px;" |After Eisenmenger syndrome<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Holosystolic murmur<br />
* May mimic aortic stenosis(mid/end dyastolic murmur due to increased pulmonary circulation)<br />
| style="background: #F5F5F5; padding: 5px;" |-/+<br />
| style="background: #F5F5F5; padding: 5px;" |-/+<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Defect localization<br />
*septal dropout in the area adjacent to the tricuspid septal leaflet and below the right border of the aortic annulus<br />
* Direction of jet<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* [[Cardiomegaly]] in large VSD<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Direct visualisation of murmur<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Echocardiogram<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"<br />
!Diseases<br />
!Exertional dyspnea<br />
! colspan="1" rowspan="1" |Failure to thrive<br />
!Recurrent respiratory infections<br />
!Murmur on auscultation<br />
! colspan="1" rowspan="1" |Peripheral edema<br />
!Clubbing<br />
!Echocardiography<br />
!Chest x-ray<br />
!Cardiac CT<br />
|'''Gold standard'''<br />
!Additional findings<br />
|-<br />
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Patent ductus arteriosus]]<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Not at beginning<br />
* May be produced during the course of disease <br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Depends on the size<br />
| style="background: #F5F5F5; padding: 5px;" | -<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Continuous machine-like murmur<br />
| style="background: #F5F5F5; padding: 5px;" |-<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* May be present by progressing<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Golden standard <br />
* In color-Doppler visualization of flow through the patent duct which has a high velocity<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Non-specific<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Used for determining Krichenko classification<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Echocardiogram<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Krichenko criteria for classification is a very important factor for treatment<br />
|-<br />
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Aortic coarctation|Coarctation of the aorta]]<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/−<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/−<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Systolic murmur over the upper sternal border with radiation to the back<br />
*Murmur of mitral regurgitation (holosystolic murmur best heard at the apex)<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Narrowing of the aortic arch at the level of the isthmus<br />
* Left ventricular hypertrophy<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Notching of the posterior fourth to eighth ribs due to dilated intercostal arteries<br />
* Indentation of the aorta at the site of coarctation with pre- and post-stenotic dilation of the aorta (classic "3 sign")<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Dilation of the intercostal arteries<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Echocardiogram<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
*Patients present with arm-leg blood pressure gradient of >20mmHg<br />
|-<br />
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Aortic stenosis]]<br />
| style="background: #F5F5F5; padding: 5px;" |+<br />
| style="background: #F5F5F5; padding: 5px;" |+<br />
| style="background: #F5F5F5; padding: 5px;" |+<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Crescendo-decrescendo mid-systolic (or ejection systolic) murmur<br />
| style="background: #F5F5F5; padding: 5px;" |+/-<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Depending on severity<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Used for finding the location of stenosis<br />
* Finding severity<br />
* Evaluating the flow jet with color-Doppler ultrasound technique<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Non-specific at the beginning<br />
* At progressed stage calcification of the valve and cardiomegally<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
*[[Aortic calcification|Calcification score]]<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* MRI<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* MRI provides a more detailed structural and dynamic assessment of the aortic valve and left ventricle, in particular<br />
|-<br />
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Pulmonary valve stenosis|Pulmonary stenosis]]<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Depending on severity<br />
| style="background: #F5F5F5; padding: 5px;" | -<br />
| style="background: #F5F5F5; padding: 5px;" | -/+<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Continuous systolic murmur<br />
| style="background: #F5F5F5; padding: 5px;" |-<br />
| style="background: #F5F5F5; padding: 5px;" | -/+<br />
| style="background: #F5F5F5; padding: 5px;" | <br />
* Right atrial hypertrophy<br />
| style="background: #F5F5F5; padding: 5px;" | <br />
* Non-specific<br />
| style="background: #F5F5F5; padding: 5px;" | <br />
* Direct visualization of stenosis<br />
| style="background: #F5F5F5; padding: 5px;" | <br />
* Echocardiogram<br />
| style="background: #F5F5F5; padding: 5px;" | <br />
|}<br />
<br />
<br />
<br />
<br />
<br />
<br />
<br />
<br />
<br />
<br />
<br />
{| class="wikitable"<br />
|+<br />
!Diseases<br />
!Pathophysiology<br />
!Shunt<br />
!Symptoms<br />
!Diagnosis<br />
!Echocardiography findings<br />
!Physical examination<br />
!Treatment<br />
!Complications<br />
|-<br />
|Patent foramen ovale<br />
|<br />
* Failure of fusion of the septum primum and septum secundum leading to a flap valve opening.<br />
|<br />
* Right-to-left shunt<br />
<br />
* More prominent with increased right atrial pressure.<br />
|<br />
* Majority of patients are asymptomatic<br />
|<br />
* TEE (Gold standard)<br />
<br />
* TTE<br />
<br />
* TCD<br />
|<br />
* Appearance of at least 3 micro-bubbles in the left atrium within three cardiac cycles after the complete opacification of the right atrium<br />
|<br />
|<br />
* Percutaneous closure<br />
* Anticoagulants<br />
* Antiplatelets<br />
|<br />
* Paradoxical embolism<br />
<br />
* Migraine with aura<br />
*Decompression sickness in divers<br />
*Platypnea-orthodeoxia syndrome<br /><br />
|-<br />
|Atrial septal defect<br />
|<br />
* '''Ostium secundum defect''': Failure of the septum secundum to occlude the ostium secundum.<br />
<br />
* '''Ostium primum defect''': Failure of the ostium primum to fuse with the endocardial cushions.<br />
<br />
* '''Superior sinus venosus defect''': The orifice of the superior vena cava overrides the atrial septum above the fossa ovalis.<br />
<br />
* '''Inferior sinus venosus defect''': The orifice of the inferior vena cava overrides the left and right atrium.<br />
*'''Coronary sinus defect''': Absence of a portion of the common wall that separates the coronary sinus and the left atrium.<br />
|<br />
* Continuous left-to-right shunt<br />
|<br />
* Failure to thrive, tachypnea, recurrent respiratory infections, heart failure<br />
<br />
* Commonly asymptomatic during childhood and adolescence<br />
*Adults with large shunts may become symptomatic in the fourth decade presenting with fatigue, exercise intolerance, palpitations, syncope, and shortness of breath.<br />
<br />
*<br />
|<br />
* TTE (Gold standard)<br />
*Cardiac CT<br />
*Cardiac MRI<br />
|<br />
* Hypermobile interatrial septum<br />
* Abrupt septal irregularity<br />
* Right atrial and ventricular volume overload<br />
* Pulmonary artery dilation<br />
*'''Coronary sinus defect''': Enlarged ostium of the coronary sinus and unroofing of the terminal portion of the coronary sinus<br />
|<br />
* Systolic flow murmur in the pulmonary valve region<br />
*Wide, fixed splitting of S2<br />
*Diastolic flow rumble across the tricuspid valve<br />
*Right ventricular heave <br />
|<br />
* Spontaneous closure<br />
*Percutaneous transcatheter closure<br />
*Surgical closure<br />
|<br />
* Right sided heart failure<br />
* Peripheral edema<br />
* Eisenmenger syndrome (cyanosis)<br />
* Paradoxical emboli<br />
* Pulmonary hypertension<br />
|-<br />
|Pulmonary ateriovenous fistula<br />
|<br />
* Abnormal blood vessel(s) connecting the pulmonary arteries and veins directly without interposition of pulmonary capillaries<br />
|<br />
* Right-to-left shunt between the pulmonary artery and pulmonary vein<br />
|<br />
* Symptoms may occur only after the second decade<br />
*Cyanosis<br />
*Hemoptysis<br />
|<br />
* Chest CT<br />
*Pulmonary arteriogram<br />
|<br />
* Appearance of contrast bubbles in the left atrium three to five cardiac cycles after appearance in the right atrium<br />
|<br />
* Clubbing<br />
*Systolic/continuous murmur<br />
|<br />
* Embolization<br />
* Surgical resection<br />
|<br />
* Cerebral ischemia/abscess<br />
*Hemothorax<br />
|}<br />
<br />
==Differential table for aortic stenosis==<br />
<br />
{| class="wikitable"<br />
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;|Diseases<br />
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;|History<br />
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;|Symptoms<br />
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;|Physical Examination<br />
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;|Murmur<br />
! colspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;|Diagnosis<br />
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;|Other Findings<br />
|- style="background: #DCDCDC; padding: 5px; text-align: center;"<br />
!style="background: #4479BA; color: #FFFFFF; text-align: center;|ECG<br />
!style="background: #4479BA; color: #FFFFFF; text-align: center;|CXR<br />
!style="background: #4479BA; color: #FFFFFF; text-align: center;|Echocardiogram<br />
!style="background: #4479BA; color: #FFFFFF; text-align: center;|Cardiac Catheterization<br />
|-<br />
|style="background: #DCDCDC; padding: 5px; text-align: center;" |Aortic stenosis<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Age (aortic valve calcification)<br />
*Syncope<br />
*Orthopnea<br />
*Paroxysmal nocturnal dyspnea<br />
*Acute rheumatic fever<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Chest pain<br />
*Dyspnea on exertion<br />
*Palpitations<br />
*Symptoms of heart failure<br />
| style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Pulsus parvus et tardus<br />
*Pulmonary rales<br />
*Peripheral edema (In CHF patients)<br />
*Jugular venous distension<br />
*Enlarged and laterally displaced point of maximal impulse<br />
<br />
*<br />
| style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Crescendo-decrescendo systolic murmur<br />
*Best heard at the right upper sternal border<br />
*Radiation to the carotid arteries<br />
*Increases with squatting<br />
*Decreases with valsalva maneuver<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Left ventricular hypertrophy''':<br />
<br />
* Wide QRS complex (especially in leads V1-V6)<br />
*ST depression in leads V5-V6<br />
*Left axis deviation<br />
* <br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Enlarged left ventricle<br />
* Enlarged left atrium and pulmonary artery in severe cases<br />
*Calcification of the aortic valve<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Thickening and calcification of the aortic valve<br />
*Left ventricular hypertrophy<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Left heart catheterization:'''<br />
<br />
* Left ventricular and aortic pressures<br />
*The left ventricle generates higher pressures than what is transmitted to the aorta<br />
| style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Associated with von Willibrand disease<br />
|-<br />
| colspan="10" |<br />
|-<br />
|style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Mitral Stenosis]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Age ( Mitral annular calcification in older patients)<br />
<br />
* [[Rheumatic fever]]<br />
<br />
* [[Endocarditis]]<br />
<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* [[Dyspnea on exertion]]<br />
<br />
* [[Paroxysmal nocturnal dyspnea]]<br />
<br />
* [[Orthopnea]]<br />
<br />
* New onset [[atrial fibrillation]]<br />
<br />
| style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Mitral facies<br />
<br />
* Heart murmur<br />
<br />
* [[JVD|Jugular vein distension]]<br />
<br />
* Apical impulse displaced laterally or not palpable <br />
<br />
* Diastolic thrill at the apex <br />
<br />
* Signs of heart failure in severe cases<br />
| style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Diastolic murmur<br />
<br />
* Low pitched<br />
<br />
* Opening snap followed by decrescendo-crescendo rumbling murmur <br />
<br />
* Best heard with the bell of the stethoscope at apex at end-expiration in left lateral decubitus position <br />
<br />
* Intensity increases after a [[valsalva maneuver]], after exercise and after increased after load (eg., squatting, isometric hand grip) <br />
| style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* [[P mitrale]]<br />
* [[Atrial fibrillation]]: No P waves and irregularly irregular rhythm<br />
<br />
* [[Right axis deviation]]<br />
<br />
* Right ventricular hypertropy: Dominant R wave in V1 and V2<br />
| style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Straightening of the left border of the heart suggestive of enlargement of the [[left atrium]]<br />
<br />
* Double right heart border (Enlarged left atrium and normal right atrium) <br />
<br />
* Prominent left atrial appendage<br />
<br />
* Splaying of [[carina|subcarinal angle]] (>120 degrees)<br />
<br />
* Calcification of [[mitral valve]]<br />
<br />
* [[Kerley B lines]] <br />
<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Reduced valve leaflet mobility<br />
<br />
* Valve calcification <br />
<br />
* Doming of mitral valve<br />
<br />
* Valve thickening <br />
* Enlargement of left atrium <br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Right heart catheterization:'''<br />
* [[Pulmonary capillary wedge pressure]] (left atrial pressure) <br />
'''Left heart catheterization:'''<br />
* Pressures in left ventricle<br />
<br />
* Determines the gradient between the left and right atrium during ventricular diastole (marker of the severity of mitral stenosis)<br />
<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* [[Hemoptysis]] ([[heart failure]])<br />
<br />
* [[Ortner's syndrome]]<br />
|-<br />
| colspan="10" |<br />
|-<br />
|style="vertical-align: top;background: #DCDCDC; padding: 5px; text-align: center;" |[[Mitral Regurgitation]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* [[CAD]]<br />
<br />
* [[MI]]<br />
<br />
* [[Rheumatic fever]]<br />
<br />
* [[Endocarditis]]<br />
<br />
* [[Mitral valve prolapse]]<br />
<br />
* [[Cardiomyopathy]]<br />
<br />
* [[Radiation therapy]]<br />
<br />
* Trauma<br />
<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* [[Palpitations]]<br />
<br />
* Symptoms of heart failure in severe cases<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Palpation'''<br />
* Brisk carotid upstroke and hyperdymanic carotid impulse on palpation<br />
<br />
* Apical impulse is displaced to left<br />
<br />
* S3 and a palpable thrill<br />
'''Auscultation'''<br />
* Murmur<br />
<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* [[Holosystolic murmur]]<br />
<br />
* High pitched, blowing<br />
<br />
* Radiates to axilla<br />
<br />
* Best heard with the diaphragm of the stethoscope at apex in left lateral [[decubitus]] position<br />
<br />
* Intensity increases with hand grip or squatting <br />
<br />
* Decrease in intensity on standing or [[valsalva maneuver]] <br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* [[P mitrale]] in lead II<br />
* Increased QRS voltage<br />
* [[Right axis deviation]]<br />
* [[Atrial fibrillation]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Acute MR'''<br />
* [[Kerley B lines]]<br />
* No enlargement of cardiac silhouette<br />
'''Chronic MR'''<br />
* Enlarged cardiac silhouette<br />
* Straightening of left heart border<br />
* Splaying of subcarinal angle<br />
* Calcification of mitral annulus<br />
* Double right heart border<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Enlargement of left atrium and ventricle<br />
* Identify valve abnormality<br />
* Valve calcification<br />
* Severity of regurgitation<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Grading of MR is done with left ventriculography<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Decompensated and acute MR may lead to [[heart failure]]<br />
|-<br />
| colspan="10" |<br />
|-<br />
|style="vertical-align: top;background: #DCDCDC; padding: 5px; text-align: center;" |[[Atrial septal defect]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Frequent respiratory or lung infections<br />
* [[Dyspnea]]<br />
* Tiring when feeding (Infants)<br />
* Shortness of breath on exertion<br />
* [[Palpitations]]<br />
* Swelling of feet<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* [[Shortness of breath]]<br />
* [[Fatigue]]<br />
* [[Failure to thrive]]<br />
* Swelling of feet and abdomen ([[Right heart failure]])<br />
* [[Palpitations]]<br />
* Respiratory infections<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Inspection'''<br />
* Precordial bulge<br />
* Precordial lift<br />
'''Palpation'''<br />
* Right ventricular impulse<br />
* Pulmonary artery pulsations<br />
* Thrill<br />
'''Auscultation'''<br />
* Murmur<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Midsystolic (ejection systolic) murmur<br />
<br />
* Widely split, fixed S2<br />
<br />
* Upper left sternal border<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Normal <br />
* Prolonged PR interval<br />
* [[Right bundle branch block]]<br />
* ECG findings varies according to the underlying type of ASD<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
*Increased pulmonary markings<br />
*[[Cardiomegaly]]<br />
*Triangular appearance of heart<br />
*Schimitar sign<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Gold standard test for diagnosis of atrial septal defect (for more information click [[Atrial septal defect echocardiography]])<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Defect size<br />
* Pulmonary venous return<br />
* [[Pulmonary vascular resistance]]<br />
* [[Pulmonary artery hypertension]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Asymptomatic until later part of their life<br />
* May be associated with [[migraine with aura]]<br />
|-<br />
| colspan="10" |<br />
|-<br />
|style="vertical-align: top;background: #DCDCDC; padding: 5px; text-align: center;" |[[Atrial myxoma|Left Atrial Myxoma]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* [[Dyspnea]]<br />
* [[Orthopnea]]<br />
* [[Pulmonary edema]]<br />
* Hyperpigmentation of skin and endocrine activity<br />
* Cerebral [[embolism]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Symptoms may mimic mitral stenosis<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Skin'''<br />
* Signs of an embolic phenomenon<br />
* [[Raynaud's phenomenon]]<br />
* Swelling<br />
* Clubbing<br />
'''Auscultation:'''<br />
* Lung: Fine crepitations <br />
<br />
* Heart: Characteristic "tumor plop" <br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Early diastolic sound as "tumor plop"<br />
<br />
* Low frequency diastolic murmur may be heard if the tumor obstructing mitral valve <br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Often normal<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Often normal<br />
'''Rare findings:'''<br />
* [[cardiomegaly]]<br />
* Left atrial enlargement<br />
* tumor calcification etc.,<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Initial and most useful diagnostic study<br />
* For more information click [[Myxoma echocardiography or ultrasound]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Useful to detect vascular supply of the tumor by the coronary arteries <br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Associated with Carney complex (genetic predisposition)<br />
|-<br />
| colspan="10" |<br />
|-<br />
|style="vertical-align: top;background: #DCDCDC; padding: 5px; text-align: center;" |Prosthetic Valve Obstruction<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* History of valve replacement<br />
* Systemic embolism<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Shortness of breath<br />
* Fatigue<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Ausculation'''<br />
<br />
Muffling of murmur<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Muffling or disappearance of prosthetic sounds<br />
<br />
* Appearance of new regurgitant or obstructive murmur <br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Degree of stenosis<br />
* Assess thrombus size and location<br />
* Differentiate between thrombus, [[pannus]] and vegetations<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |Causes:<br />
* Thrombus<br />
* Pannus formation<br />
|-<br />
| colspan="10" |<br />
|-<br />
|style="vertical-align: top;background: #DCDCDC; padding: 5px; text-align: center;" |[[Cor Triatriatum]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Dyspnea on exertion <br />
* Recent onset of [[congestive heart failure]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Dsypnea on exertion<br />
* Orthopnea<br />
* Tachypnea<br />
* Palpitations<br />
* Growth failure<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Auscultation'''<br />
* Murmur<br />
'''Other findings'''<br />
* Signs of heart failure<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Diastolic murmur with loud P2<br />
<br />
* No opening snap or a loud S1<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |Non specific but may have<br />
* [[Right axis deviation]]<br />
* Right atrial enlargement<br />
* [[Right ventricular hypertrophy]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Normal cardiac silhouette<br />
* Hemodynamic changes similar to mitral stenosis (non specific findings)<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Direct visualization of membrane through the atrium<br />
* +/- visualization of accessory chamber<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Normal left ventricular hemodynamic profile with a trans atrial gradient<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |Types<br />
* Cor triatriatum sinistrum<br />
* Cor triatriatum dextrum<br />
|-<br />
| colspan="10" |<br />
|-<br />
|style="vertical-align: top;background: #DCDCDC; padding: 5px; text-align: center;" |Congenital Mitral Stenosis<br />
| style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Respiratory distress shortly after birth<br />
* Recurrent severe pulmonary infections<br />
* Other associated congenital cardiovascular anamolies<br />
* [[Atrial fibrillation]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
<br />
'''Infants:'''<br />
* Exhaustion and sweating on feeding<br />
* Rapid breathing<br />
* [[Failure to thrive]]<br />
* Pulmonary infections <br />
* Chronic cough<br />
'''Older patients:'''<br />
* Dyspnea<br />
* Orthopnea<br />
* Paroxysmal nocturnal dyspnea<br />
* Peripheral edema<br />
* Fatigue<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Auscultation'''<br />
* Murmur<br />
'''Other findings'''<br />
* Signs of heart failure<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Mild-Moderate'''<br />
* Loud S1<br />
<br />
* Loud P2<br />
<br />
* Low frequency diastolic murmur best heard at the apex <br />
'''Severe'''<br />
* Soft S1<br />
<br />
* Loud pulmonic component of S2 with minimal respiratory splitting of S2 <br />
<br />
* Holodiastolic murmur with presystolic accentuation best heard at the apex <br />
<br />
* Early diastolic murmur of pulmonic valve regurgitation <br />
<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
*Sharp P waves in leads I and II<br />
*Inversion of P wave in lead III<br />
*Marked Q waves in leads II and III<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Left atrial dilation<br />
* Moderate enlargement of right heart<br />
* Pulmonary venous congestion<br />
* Esophageal compression<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Reduced valve leaflet mobility<br />
* Left atrial size<br />
* Severity of mitral stenosis<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |Very rare condition<br />
|-<br />
| colspan="10" |<br />
|-<br />
|style="vertical-align: top;background: #DCDCDC; padding: 5px; text-align: center;" |Supravalvular Ring Mitral Stenosis<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Other associated congenital heart defects<br />
* Fatigue<br />
* Frequent respiratory infections<br />
* Failure to thrive<br />
* Poor feeding<br />
* Precocious congestive heart failure <br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Shortness of breath<br />
<br />
* Tachypnea<br />
* Dyspnea<br />
* Nocturnal cough<br />
* Heamoptysis<br />
* [[Syncope]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Auscultation:'''<br />
<br />
Lungs: Fine, crepitant rales and rhonchi or wheezes may be present<br />
<br />
Heart: Murmur<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* An apical mid diastolic murmur with presystolic accentuation<br />
<br />
* No opening snap<br />
<br />
* The murmur is more prominent if associated with [[VSD]] or [[PDA]]<br />
<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Left atrial and ventricular enlargement<br />
* Alveolar edema <br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Supramitral ring''':<br />
* Associated with normal mitral valve apparatus<br />
'''Intramitral ring:'''<br />
* Hypomobility of the posterior leaflet<br />
* Reduced interpapillary muscle distance<br />
* Reduced chordal length<br />
* Dominant papillary muscle<br />
* Hypoplastic mitral annulus<br />
(Difficult to visualize membrane <1mm in size)<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Persistently elevated pulmonary venous pressures<br />
* Increased pulmonary artery pressure<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Types'''<br />
* Supramitral<br />
* Intramitral<br />
It is attached between the opening of the atrial appendage and the mitral annulus which helps in differentiating with Cor triatriatum sinister.<br />
* Intramitral type is associated with shone complex<br />
|}</div>
Ifeoma odukwe
https://www.wikidoc.org/index.php?title=Sandbox:_Ifeoma&diff=1608419
Sandbox: Ifeoma
2020-05-16T15:34:08Z
<p>Ifeoma odukwe: </p>
<hr />
<div>Wikidoc practice session<br />
<br />
==Overview==<br />
<br />
==Pathophysiology==<br />
<br />
===Breast Physiology===<br />
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==Classification of dextrocardia==<br />
{| style="border: 0px; font-size: 90%; margin: 3px; width: 1000px"<br />
|valign=top|<br />
|+<br />
! style="background: #4479BA; width: 250px; color: #FFFFFF;"|'''Dextrocardia Types'''<br />
<br />
! style="background: #4479BA; width: 600px; color: #FFFFFF;"|'''Description'''<br />
<br />
|-<br />
<br />
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align=center | '''Dextrocardia with situs solitus '''|| style="padding: 5px 5px; background: #F5F5F5;" |<br />
:* Dextrocardia with normally related great arteries and D-transposition (complete transposition) or L-transposition (congenitally corrected transposition) of the great arteries. Some examples include dextrocardia with D-loop ventricles and normally related great arteries, with L-loop ventricles and L-TGA (congenitally corrected TGA).<br />
:* Embryologic failure of the final leftward shift of the ventricles during development results in dextrocardia with situs solitus, D-loop ventricles, and normally related great arteries.<br />
<br />
|-<br />
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| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align=center | '''Dextrocardia with situs inversus '''|| style="padding: 5px 5px; background: #F5F5F5;"|<br />
:* May present with dextrocardia with inversely related great arteries and D-transposition (congenitally corrected transposition) or L-transposition (“uncorrected” transposition) of the great arteries. An example is dextrocardia with D-loop ventricles and D-TGA (congenitally corrected TGA).<br />
<br />
|-<br />
<br />
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align=center | '''Dextrocardia with situs ambiguous (either polyspenia or asplenia)''' || style="padding: 5px 5px; background: #F5F5F5;"|<br />
:* Dextrocardia with any of the above relationships between the ventricles and great vessels.<br />
<br />
|-<br />
<br />
<br />
{|<br />
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"<br />
! rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;|Diseases<br />
| colspan="6" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;|'''Clinical manifestations'''<br />
! colspan="3" rowspan="2" |Para-clinical findings<br />
| colspan="1" rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;|'''Gold standard'''<br />
! rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;|Additional findings<br />
|-<br />
| colspan="3" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;|'''Symptoms'''<br />
! colspan="3" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;|Physical examination<br />
|-<br />
! colspan="3" style="background: #4479BA; color: #FFFFFF; text-align: center;|Imaging<br />
|- <br />
! style="background: #4479BA; color: #FFFFFF; text-align: center;|Exertional dyspnea<br />
! colspan="1" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;|Failure to thrive<br />
! style="background: #4479BA; color: #FFFFFF; text-align: center;|Recurrent respiratory infections<br />
! style="background: #4479BA; color: #FFFFFF; text-align: center;|Murmur on auscultation<br />
! colspan="1" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;|Peripheral edema<br />
! style="background: #4479BA; color: #FFFFFF; text-align: center;|Clubbing<br />
! style="background: #4479BA; color: #FFFFFF; text-align: center;|Echocardiography<br />
! style="background: #4479BA; color: #FFFFFF; text-align: center;|Chest x-ray<br />
! style="background: #4479BA; color: #FFFFFF; text-align: center;|Cardiac CT<br />
|-<br />
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Patent foramen ovale]]<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Appearance of at least 3 micro-bubbles in the left atrium within three cardiac cycles after complete opacification of the right atrium<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | Non specific<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | <br />
* A contrast agent jet from the left atrium to the right atrium toward the inferior vena cava with channel-like appearance of the interatrial septum<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Echocardiogram<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* It is associated with paradoxical embolism, migraine headache, and decompression sickness in divers<br />
|-<br />
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Atrial septal defect]]<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/−<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/−<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/− <br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Systolic flow murmur in the upper left sternal border<br />
* Wide, fixed splitting of S2<br />
* Diastolic flow rumble across the tricuspid valve<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/−<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/−<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Hypermobile interatrial septum<br />
* Abrupt septal irregularity<br />
* Right atrial and ventricular volume overload<br />
* Pulmonary artery dilatation<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Cardiomegaly <br />
* Pulmonary artery enlargement/increased pulmonary vascularity<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Enlargement of the right atrium and ventricle<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Echocardiogram<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Atrial septal defect is classified into 5 types including ostium primum defect, ostium secundum defect, superior sinus venosus defect, inferior sinus venosus defect, and coronary sinus defect<br />
|-<br />
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Ventricular septal defect]]<br />
| style="background: #F5F5F5; padding: 5px;" |-/+<br />
| style="background: #F5F5F5; padding: 5px;" |-/+<br />
| style="background: #F5F5F5; padding: 5px;" |After Eisenmenger syndrome<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Holosystolic murmur<br />
* May mimic aortic stenosis(mid/end dyastolic murmur due to increased pulmonary circulation)<br />
| style="background: #F5F5F5; padding: 5px;" |-/+<br />
| style="background: #F5F5F5; padding: 5px;" |-/+<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Defect localization<br />
*septal dropout in the area adjacent to the tricuspid septal leaflet and below the right border of the aortic annulus<br />
* Direction of jet<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* [[Cardiomegaly]] in large VSD<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Direct visualisation of murmur<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Echocardiogram<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"<br />
!Diseases<br />
!Exertional dyspnea<br />
! colspan="1" rowspan="1" |Failure to thrive<br />
!Recurrent respiratory infections<br />
!Murmur on auscultation<br />
! colspan="1" rowspan="1" |Peripheral edema<br />
!Clubbing<br />
!Echocardiography<br />
!Chest x-ray<br />
!Cardiac CT<br />
|'''Gold standard'''<br />
!Additional findings<br />
|-<br />
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Patent ductus arteriosus]]<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Not at beginning<br />
* May be produced during the course of disease <br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Depends on the size<br />
| style="background: #F5F5F5; padding: 5px;" | -<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Continuous machine-like murmur<br />
| style="background: #F5F5F5; padding: 5px;" |-<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* May be present by progressing<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Golden standard <br />
* In color-Doppler visualization of flow through the patent duct which has a high velocity<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Non-specific<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Used for determining Krichenko classification<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Echocardiogram<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Krichenko criteria for classification is a very important factor for treatment<br />
|-<br />
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Aortic coarctation|Coarctation of the aorta]]<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/−<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/−<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Systolic murmur over the upper sternal border with radiation to the back<br />
*Murmur of mitral regurgitation (holosystolic murmur best heard at the apex)<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Narrowing of the aortic arch at the level of the isthmus<br />
* Left ventricular hypertrophy<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Notching of the posterior fourth to eighth ribs due to dilated intercostal arteries<br />
* Indentation of the aorta at the site of coarctation with pre- and post-stenotic dilation of the aorta (classic "3 sign")<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Dilation of the intercostal arteries<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Echocardiogram<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
*Patients present with arm-leg blood pressure gradient of >20mmHg<br />
|-<br />
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Aortic stenosis]]<br />
| style="background: #F5F5F5; padding: 5px;" |+<br />
| style="background: #F5F5F5; padding: 5px;" |+<br />
| style="background: #F5F5F5; padding: 5px;" |+<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Crescendo-decrescendo mid-systolic (or ejection systolic) murmur<br />
| style="background: #F5F5F5; padding: 5px;" |+/-<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Depending on severity<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Used for finding the location of stenosis<br />
* Finding severity<br />
* Evaluating the flow jet with color-Doppler ultrasound technique<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Non-specific at the beginning<br />
* At progressed stage calcification of the valve and cardiomegally<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
*[[Aortic calcification|Calcification score]]<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* MRI<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* MRI provides a more detailed structural and dynamic assessment of the aortic valve and left ventricle, in particular<br />
|-<br />
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Pulmonary valve stenosis|Pulmonary stenosis]]<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Depending on severity<br />
| style="background: #F5F5F5; padding: 5px;" | -<br />
| style="background: #F5F5F5; padding: 5px;" | -/+<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Continuous systolic murmur<br />
| style="background: #F5F5F5; padding: 5px;" |-<br />
| style="background: #F5F5F5; padding: 5px;" | -/+<br />
| style="background: #F5F5F5; padding: 5px;" | <br />
* Right atrial hypertrophy<br />
| style="background: #F5F5F5; padding: 5px;" | <br />
* Non-specific<br />
| style="background: #F5F5F5; padding: 5px;" | <br />
* Direct visualization of stenosis<br />
| style="background: #F5F5F5; padding: 5px;" | <br />
* Echocardiogram<br />
| style="background: #F5F5F5; padding: 5px;" | <br />
|}<br />
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{| class="wikitable"<br />
|+<br />
!Diseases<br />
!Pathophysiology<br />
!Shunt<br />
!Symptoms<br />
!Diagnosis<br />
!Echocardiography findings<br />
!Physical examination<br />
!Treatment<br />
!Complications<br />
|-<br />
|Patent foramen ovale<br />
|<br />
* Failure of fusion of the septum primum and septum secundum leading to a flap valve opening.<br />
|<br />
* Right-to-left shunt<br />
<br />
* More prominent with increased right atrial pressure.<br />
|<br />
* Majority of patients are asymptomatic<br />
|<br />
* TEE (Gold standard)<br />
<br />
* TTE<br />
<br />
* TCD<br />
|<br />
* Appearance of at least 3 micro-bubbles in the left atrium within three cardiac cycles after the complete opacification of the right atrium<br />
|<br />
|<br />
* Percutaneous closure<br />
* Anticoagulants<br />
* Antiplatelets<br />
|<br />
* Paradoxical embolism<br />
<br />
* Migraine with aura<br />
*Decompression sickness in divers<br />
*Platypnea-orthodeoxia syndrome<br /><br />
|-<br />
|Atrial septal defect<br />
|<br />
* '''Ostium secundum defect''': Failure of the septum secundum to occlude the ostium secundum.<br />
<br />
* '''Ostium primum defect''': Failure of the ostium primum to fuse with the endocardial cushions.<br />
<br />
* '''Superior sinus venosus defect''': The orifice of the superior vena cava overrides the atrial septum above the fossa ovalis.<br />
<br />
* '''Inferior sinus venosus defect''': The orifice of the inferior vena cava overrides the left and right atrium.<br />
*'''Coronary sinus defect''': Absence of a portion of the common wall that separates the coronary sinus and the left atrium.<br />
|<br />
* Continuous left-to-right shunt<br />
|<br />
* Failure to thrive, tachypnea, recurrent respiratory infections, heart failure<br />
<br />
* Commonly asymptomatic during childhood and adolescence<br />
*Adults with large shunts may become symptomatic in the fourth decade presenting with fatigue, exercise intolerance, palpitations, syncope, and shortness of breath.<br />
<br />
*<br />
|<br />
* TTE (Gold standard)<br />
*Cardiac CT<br />
*Cardiac MRI<br />
|<br />
* Hypermobile interatrial septum<br />
* Abrupt septal irregularity<br />
* Right atrial and ventricular volume overload<br />
* Pulmonary artery dilation<br />
*'''Coronary sinus defect''': Enlarged ostium of the coronary sinus and unroofing of the terminal portion of the coronary sinus<br />
|<br />
* Systolic flow murmur in the pulmonary valve region<br />
*Wide, fixed splitting of S2<br />
*Diastolic flow rumble across the tricuspid valve<br />
*Right ventricular heave <br />
|<br />
* Spontaneous closure<br />
*Percutaneous transcatheter closure<br />
*Surgical closure<br />
|<br />
* Right sided heart failure<br />
* Peripheral edema<br />
* Eisenmenger syndrome (cyanosis)<br />
* Paradoxical emboli<br />
* Pulmonary hypertension<br />
|-<br />
|Pulmonary ateriovenous fistula<br />
|<br />
* Abnormal blood vessel(s) connecting the pulmonary arteries and veins directly without interposition of pulmonary capillaries<br />
|<br />
* Right-to-left shunt between the pulmonary artery and pulmonary vein<br />
|<br />
* Symptoms may occur only after the second decade<br />
*Cyanosis<br />
*Hemoptysis<br />
|<br />
* Chest CT<br />
*Pulmonary arteriogram<br />
|<br />
* Appearance of contrast bubbles in the left atrium three to five cardiac cycles after appearance in the right atrium<br />
|<br />
* Clubbing<br />
*Systolic/continuous murmur<br />
|<br />
* Embolization<br />
* Surgical resection<br />
|<br />
* Cerebral ischemia/abscess<br />
*Hemothorax<br />
|}<br />
<br />
==Differential table for aortic stenosis==<br />
<br />
{| class="wikitable"<br />
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;|Diseases<br />
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;|History<br />
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;|Symptoms<br />
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;|Physical Examination<br />
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;|Murmur<br />
! colspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;|Diagnosis<br />
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;|Other Findings<br />
|- style="background: #DCDCDC; padding: 5px; text-align: center;"<br />
!style="background: #4479BA; color: #FFFFFF; text-align: center;|ECG<br />
!style="background: #4479BA; color: #FFFFFF; text-align: center;|CXR<br />
!style="background: #4479BA; color: #FFFFFF; text-align: center;|Echocardiogram<br />
!style="background: #4479BA; color: #FFFFFF; text-align: center;|Cardiac Catheterization<br />
|-<br />
|style="background: #DCDCDC; padding: 5px; text-align: center;" |Aortic stenosis<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Age (aortic valve calcification)<br />
*Syncope<br />
*Orthopnea<br />
*Paroxysmal nocturnal dyspnea<br />
*Acute rheumatic fever<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Chest pain<br />
*Dyspnea on exertion<br />
*Palpitations<br />
*Symptoms of heart failure<br />
| style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Pulsus parvus et tardus<br />
*Pulmonary rales<br />
*Peripheral edema (In CHF patients)<br />
*Jugular venous distension<br />
*Enlarged and laterally displaced point of maximal impulse<br />
<br />
*<br />
| style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Crescendo-decrescendo systolic murmur<br />
*Best heard at the right upper sternal border<br />
*Radiation to the carotid arteries<br />
*Increases with squatting<br />
*Decreases with valsalva maneuver<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Left ventricular hypertrophy''':<br />
<br />
* Wide QRS complex (especially in leads V1-V6)<br />
*ST depression in leads V5-V6<br />
*Left axis deviation<br />
* <br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Enlarged left ventricle<br />
* Enlarged left atrium and pulmonary artery in severe cases<br />
*Calcification of the aortic valve<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Thickening and calcification of the aortic valve<br />
*Left ventricular hypertrophy<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Left heart catheterization:'''<br />
<br />
* Left ventricular and aortic pressures<br />
*The left ventricle generates higher pressures than what is transmitted to the aorta<br />
| style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Associated with von Willibrand disease<br />
|-<br />
| colspan="10" |<br />
|-<br />
|style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Mitral Stenosis]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Age ( Mitral annular calcification in older patients)<br />
<br />
* [[Rheumatic fever]]<br />
<br />
* [[Endocarditis]]<br />
<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* [[Dyspnea on exertion]]<br />
<br />
* [[Paroxysmal nocturnal dyspnea]]<br />
<br />
* [[Orthopnea]]<br />
<br />
* New onset [[atrial fibrillation]]<br />
<br />
| style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Mitral facies<br />
<br />
* Heart murmur<br />
<br />
* [[JVD|Jugular vein distension]]<br />
<br />
* Apical impulse displaced laterally or not palpable <br />
<br />
* Diastolic thrill at the apex <br />
<br />
* Signs of heart failure in severe cases<br />
| style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Diastolic murmur<br />
<br />
* Low pitched<br />
<br />
* Opening snap followed by decrescendo-crescendo rumbling murmur <br />
<br />
* Best heard with the bell of the stethoscope at apex at end-expiration in left lateral decubitus position <br />
<br />
* Intensity increases after a [[valsalva maneuver]], after exercise and after increased after load (eg., squatting, isometric hand grip) <br />
| style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* [[P mitrale]]<br />
* [[Atrial fibrillation]]: No P waves and irregularly irregular rhythm<br />
<br />
* [[Right axis deviation]]<br />
<br />
* Right ventricular hypertropy: Dominant R wave in V1 and V2<br />
| style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Straightening of the left border of the heart suggestive of enlargement of the [[left atrium]]<br />
<br />
* Double right heart border (Enlarged left atrium and normal right atrium) <br />
<br />
* Prominent left atrial appendage<br />
<br />
* Splaying of [[carina|subcarinal angle]] (>120 degrees)<br />
<br />
* Calcification of [[mitral valve]]<br />
<br />
* [[Kerley B lines]] <br />
<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Reduced valve leaflet mobility<br />
<br />
* Valve calcification <br />
<br />
* Doming of mitral valve<br />
<br />
* Valve thickening <br />
* Enlargement of left atrium <br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Right heart catheterization:'''<br />
* [[Pulmonary capillary wedge pressure]] (left atrial pressure) <br />
'''Left heart catheterization:'''<br />
* Pressures in left ventricle<br />
<br />
* Determines the gradient between the left and right atrium during ventricular diastole (marker of the severity of mitral stenosis)<br />
<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* [[Hemoptysis]] ([[heart failure]])<br />
<br />
* [[Ortner's syndrome]]<br />
|-<br />
| colspan="10" |<br />
|-<br />
|style="vertical-align: top;background: #DCDCDC; padding: 5px; text-align: center;" |[[Mitral Regurgitation]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* [[CAD]]<br />
<br />
* [[MI]]<br />
<br />
* [[Rheumatic fever]]<br />
<br />
* [[Endocarditis]]<br />
<br />
* [[Mitral valve prolapse]]<br />
<br />
* [[Cardiomyopathy]]<br />
<br />
* [[Radiation therapy]]<br />
<br />
* Trauma<br />
<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* [[Palpitations]]<br />
<br />
* Symptoms of heart failure in severe cases<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Palpation'''<br />
* Brisk carotid upstroke and hyperdymanic carotid impulse on palpation<br />
<br />
* Apical impulse is displaced to left<br />
<br />
* S3 and a palpable thrill<br />
'''Auscultation'''<br />
* Murmur<br />
<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* [[Holosystolic murmur]]<br />
<br />
* High pitched, blowing<br />
<br />
* Radiates to axilla<br />
<br />
* Best heard with the diaphragm of the stethoscope at apex in left lateral [[decubitus]] position<br />
<br />
* Intensity increases with hand grip or squatting <br />
<br />
* Decrease in intensity on standing or [[valsalva maneuver]] <br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* [[P mitrale]] in lead II<br />
* Increased QRS voltage<br />
* [[Right axis deviation]]<br />
* [[Atrial fibrillation]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Acute MR'''<br />
* [[Kerley B lines]]<br />
* No enlargement of cardiac silhouette<br />
'''Chronic MR'''<br />
* Enlarged cardiac silhouette<br />
* Straightening of left heart border<br />
* Splaying of subcarinal angle<br />
* Calcification of mitral annulus<br />
* Double right heart border<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Enlargement of left atrium and ventricle<br />
* Identify valve abnormality<br />
* Valve calcification<br />
* Severity of regurgitation<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Grading of MR is done with left ventriculography<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Decompensated and acute MR may lead to [[heart failure]]<br />
|-<br />
| colspan="10" |<br />
|-<br />
|style="vertical-align: top;background: #DCDCDC; padding: 5px; text-align: center;" |[[Atrial septal defect]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Frequent respiratory or lung infections<br />
* [[Dyspnea]]<br />
* Tiring when feeding (Infants)<br />
* Shortness of breath on exertion<br />
* [[Palpitations]]<br />
* Swelling of feet<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* [[Shortness of breath]]<br />
* [[Fatigue]]<br />
* [[Failure to thrive]]<br />
* Swelling of feet and abdomen ([[Right heart failure]])<br />
* [[Palpitations]]<br />
* Respiratory infections<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Inspection'''<br />
* Precordial bulge<br />
* Precordial lift<br />
'''Palpation'''<br />
* Right ventricular impulse<br />
* Pulmonary artery pulsations<br />
* Thrill<br />
'''Auscultation'''<br />
* Murmur<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Midsystolic (ejection systolic) murmur<br />
<br />
* Widely split, fixed S2<br />
<br />
* Upper left sternal border<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Normal <br />
* Prolonged PR interval<br />
* [[Right bundle branch block]]<br />
* ECG findings varies according to the underlying type of ASD<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
*Increased pulmonary markings<br />
*[[Cardiomegaly]]<br />
*Triangular appearance of heart<br />
*Schimitar sign<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Gold standard test for diagnosis of atrial septal defect (for more information click [[Atrial septal defect echocardiography]])<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Defect size<br />
* Pulmonary venous return<br />
* [[Pulmonary vascular resistance]]<br />
* [[Pulmonary artery hypertension]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Asymptomatic until later part of their life<br />
* May be associated with [[migraine with aura]]<br />
|-<br />
| colspan="10" |<br />
|-<br />
|style="vertical-align: top;background: #DCDCDC; padding: 5px; text-align: center;" |[[Atrial myxoma|Left Atrial Myxoma]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* [[Dyspnea]]<br />
* [[Orthopnea]]<br />
* [[Pulmonary edema]]<br />
* Hyperpigmentation of skin and endocrine activity<br />
* Cerebral [[embolism]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Symptoms may mimic mitral stenosis<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Skin'''<br />
* Signs of an embolic phenomenon<br />
* [[Raynaud's phenomenon]]<br />
* Swelling<br />
* Clubbing<br />
'''Auscultation:'''<br />
* Lung: Fine crepitations <br />
<br />
* Heart: Characteristic "tumor plop" <br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Early diastolic sound as "tumor plop"<br />
<br />
* Low frequency diastolic murmur may be heard if the tumor obstructing mitral valve <br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Often normal<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Often normal<br />
'''Rare findings:'''<br />
* [[cardiomegaly]]<br />
* Left atrial enlargement<br />
* tumor calcification etc.,<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Initial and most useful diagnostic study<br />
* For more information click [[Myxoma echocardiography or ultrasound]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Useful to detect vascular supply of the tumor by the coronary arteries <br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Associated with Carney complex (genetic predisposition)<br />
|-<br />
| colspan="10" |<br />
|-<br />
|style="vertical-align: top;background: #DCDCDC; padding: 5px; text-align: center;" |Prosthetic Valve Obstruction<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* History of valve replacement<br />
* Systemic embolism<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Shortness of breath<br />
* Fatigue<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Ausculation'''<br />
<br />
Muffling of murmur<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Muffling or disappearance of prosthetic sounds<br />
<br />
* Appearance of new regurgitant or obstructive murmur <br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Degree of stenosis<br />
* Assess thrombus size and location<br />
* Differentiate between thrombus, [[pannus]] and vegetations<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |Causes:<br />
* Thrombus<br />
* Pannus formation<br />
|-<br />
| colspan="10" |<br />
|-<br />
|style="vertical-align: top;background: #DCDCDC; padding: 5px; text-align: center;" |[[Cor Triatriatum]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Dyspnea on exertion <br />
* Recent onset of [[congestive heart failure]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Dsypnea on exertion<br />
* Orthopnea<br />
* Tachypnea<br />
* Palpitations<br />
* Growth failure<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Auscultation'''<br />
* Murmur<br />
'''Other findings'''<br />
* Signs of heart failure<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Diastolic murmur with loud P2<br />
<br />
* No opening snap or a loud S1<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |Non specific but may have<br />
* [[Right axis deviation]]<br />
* Right atrial enlargement<br />
* [[Right ventricular hypertrophy]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Normal cardiac silhouette<br />
* Hemodynamic changes similar to mitral stenosis (non specific findings)<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Direct visualization of membrane through the atrium<br />
* +/- visualization of accessory chamber<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Normal left ventricular hemodynamic profile with a trans atrial gradient<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |Types<br />
* Cor triatriatum sinistrum<br />
* Cor triatriatum dextrum<br />
|-<br />
| colspan="10" |<br />
|-<br />
|style="vertical-align: top;background: #DCDCDC; padding: 5px; text-align: center;" |Congenital Mitral Stenosis<br />
| style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Respiratory distress shortly after birth<br />
* Recurrent severe pulmonary infections<br />
* Other associated congenital cardiovascular anamolies<br />
* [[Atrial fibrillation]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
<br />
'''Infants:'''<br />
* Exhaustion and sweating on feeding<br />
* Rapid breathing<br />
* [[Failure to thrive]]<br />
* Pulmonary infections <br />
* Chronic cough<br />
'''Older patients:'''<br />
* Dyspnea<br />
* Orthopnea<br />
* Paroxysmal nocturnal dyspnea<br />
* Peripheral edema<br />
* Fatigue<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Auscultation'''<br />
* Murmur<br />
'''Other findings'''<br />
* Signs of heart failure<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Mild-Moderate'''<br />
* Loud S1<br />
<br />
* Loud P2<br />
<br />
* Low frequency diastolic murmur best heard at the apex <br />
'''Severe'''<br />
* Soft S1<br />
<br />
* Loud pulmonic component of S2 with minimal respiratory splitting of S2 <br />
<br />
* Holodiastolic murmur with presystolic accentuation best heard at the apex <br />
<br />
* Early diastolic murmur of pulmonic valve regurgitation <br />
<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
*Sharp P waves in leads I and II<br />
*Inversion of P wave in lead III<br />
*Marked Q waves in leads II and III<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Left atrial dilation<br />
* Moderate enlargement of right heart<br />
* Pulmonary venous congestion<br />
* Esophageal compression<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Reduced valve leaflet mobility<br />
* Left atrial size<br />
* Severity of mitral stenosis<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |Very rare condition<br />
|-<br />
| colspan="10" |<br />
|-<br />
|style="vertical-align: top;background: #DCDCDC; padding: 5px; text-align: center;" |Supravalvular Ring Mitral Stenosis<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Other associated congenital heart defects<br />
* Fatigue<br />
* Frequent respiratory infections<br />
* Failure to thrive<br />
* Poor feeding<br />
* Precocious congestive heart failure <br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Shortness of breath<br />
<br />
* Tachypnea<br />
* Dyspnea<br />
* Nocturnal cough<br />
* Heamoptysis<br />
* [[Syncope]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Auscultation:'''<br />
<br />
Lungs: Fine, crepitant rales and rhonchi or wheezes may be present<br />
<br />
Heart: Murmur<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* An apical mid diastolic murmur with presystolic accentuation<br />
<br />
* No opening snap<br />
<br />
* The murmur is more prominent if associated with [[VSD]] or [[PDA]]<br />
<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Left atrial and ventricular enlargement<br />
* Alveolar edema <br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Supramitral ring''':<br />
* Associated with normal mitral valve apparatus<br />
'''Intramitral ring:'''<br />
* Hypomobility of the posterior leaflet<br />
* Reduced interpapillary muscle distance<br />
* Reduced chordal length<br />
* Dominant papillary muscle<br />
* Hypoplastic mitral annulus<br />
(Difficult to visualize membrane <1mm in size)<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Persistently elevated pulmonary venous pressures<br />
* Increased pulmonary artery pressure<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Types'''<br />
* Supramitral<br />
* Intramitral<br />
It is attached between the opening of the atrial appendage and the mitral annulus which helps in differentiating with Cor triatriatum sinister.<br />
* Intramitral type is associated with shone complex<br />
|}</div>
Ifeoma odukwe
https://www.wikidoc.org/index.php?title=Sandbox:_Ifeoma&diff=1608418
Sandbox: Ifeoma
2020-05-16T15:30:26Z
<p>Ifeoma odukwe: </p>
<hr />
<div>Wikidoc practice session<br />
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==Classification of dextrocardia==<br />
{| style="border: 0px; font-size: 90%; margin: 3px; width: 1000px"<br />
|valign=top|<br />
|+<br />
! style="background: #4479BA; width: 250px; color: #FFFFFF;"|'''Dextrocardia Types'''<br />
<br />
! style="background: #4479BA; width: 600px; color: #FFFFFF;"|'''Description'''<br />
<br />
|-<br />
<br />
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align=center | '''Dextrocardia with situs solitus '''|| style="padding: 5px 5px; background: #F5F5F5;" |<br />
:* Dextrocardia with normally related great arteries and D-transposition (complete transposition) or L-transposition (congenitally corrected transposition) of the great arteries. Some examples include dextrocardia with D-loop ventricles and normally related great arteries, with L-loop ventricles and L-TGA (congenitally corrected TGA).<br />
:* Embryologic failure of the final leftward shift of the ventricles during development results in dextrocardia with situs solitus, D-loop ventricles, and normally related great arteries.<br />
<br />
|-<br />
<br />
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align=center | '''Dextrocardia with situs inversus '''|| style="padding: 5px 5px; background: #F5F5F5;"|<br />
:* May present with dextrocardia with inversely related great arteries and D-transposition (congenitally corrected transposition) or L-transposition (“uncorrected” transposition) of the great arteries. An example is dextrocardia with D-loop ventricles and D-TGA (congenitally corrected TGA).<br />
<br />
|-<br />
<br />
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align=center | '''Dextrocardia with situs ambiguous (either polyspenia or asplenia)''' || style="padding: 5px 5px; background: #F5F5F5;"|<br />
:* Dextrocardia with any of the above relationships between the ventricles and great vessels.<br />
<br />
|-<br />
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<br />
{|<br />
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"<br />
! rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;|Diseases<br />
| colspan="6" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;|'''Clinical manifestations'''<br />
! colspan="3" rowspan="2" |Para-clinical findings<br />
| colspan="1" rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;|'''Gold standard'''<br />
! rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;|Additional findings<br />
|-<br />
| colspan="3" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;|'''Symptoms'''<br />
! colspan="3" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;|Physical examination<br />
|-<br />
! colspan="3" style="background: #4479BA; color: #FFFFFF; text-align: center;|Imaging<br />
|- <br />
! style="background: #4479BA; color: #FFFFFF; text-align: center;|Exertional dyspnea<br />
! colspan="1" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;|Failure to thrive<br />
! style="background: #4479BA; color: #FFFFFF; text-align: center;|Recurrent respiratory infections<br />
! style="background: #4479BA; color: #FFFFFF; text-align: center;|Murmur on auscultation<br />
! colspan="1" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;|Peripheral edema<br />
! style="background: #4479BA; color: #FFFFFF; text-align: center;|Clubbing<br />
! style="background: #4479BA; color: #FFFFFF; text-align: center;|Echocardiography<br />
! style="background: #4479BA; color: #FFFFFF; text-align: center;|Chest x-ray<br />
! style="background: #4479BA; color: #FFFFFF; text-align: center;|Cardiac CT<br />
|-<br />
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Patent foramen ovale]]<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Appearance of at least 3 micro-bubbles in the left atrium within three cardiac cycles after complete opacification of the right atrium<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | Non specific<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | <br />
* A contrast agent jet from the left atrium to the right atrium toward the inferior vena cava with channel-like appearance of the interatrial septum<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Echocardiogram<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* It is associated with paradoxical embolism, migraine headache, and decompression sickness in divers<br />
|-<br />
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Atrial septal defect]]<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/−<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/−<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/− <br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Systolic flow murmur in the upper left sternal border<br />
* Wide, fixed splitting of S2<br />
* Diastolic flow rumble across the tricuspid valve<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/−<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/−<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Hypermobile interatrial septum<br />
* Abrupt septal irregularity<br />
* Right atrial and ventricular volume overload<br />
* Pulmonary artery dilatation<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Cardiomegaly <br />
* Pulmonary artery enlargement/increased pulmonary vascularity<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Enlargement of the right atrium and ventricle<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Echocardiogram<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Atrial septal defect is classified into 5 types including ostium primum defect, ostium secundum defect, superior sinus venosus defect, inferior sinus venosus defect, and coronary sinus defect<br />
|-<br />
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Ventricular septal defect]]<br />
| style="background: #F5F5F5; padding: 5px;" |-/+<br />
| style="background: #F5F5F5; padding: 5px;" |-/+<br />
| style="background: #F5F5F5; padding: 5px;" |After Eisenmenger syndrome<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Holosystolic murmur<br />
* May mimic aortic stenosis(mid/end dyastolic murmur due to increased pulmonary circulation)<br />
| style="background: #F5F5F5; padding: 5px;" |-/+<br />
| style="background: #F5F5F5; padding: 5px;" |-/+<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Defect localization<br />
*septal dropout in the area adjacent to the tricuspid septal leaflet and below the right border of the aortic annulus<br />
* Direction of jet<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* [[Cardiomegaly]] in large VSD<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Direct visualisation of murmur<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Echocardiogram<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"<br />
!Diseases<br />
!Exertional dyspnea<br />
! colspan="1" rowspan="1" |Failure to thrive<br />
!Recurrent respiratory infections<br />
!Murmur on auscultation<br />
! colspan="1" rowspan="1" |Peripheral edema<br />
!Clubbing<br />
!Echocardiography<br />
!Chest x-ray<br />
!Cardiac CT<br />
|'''Gold standard'''<br />
!Additional findings<br />
|-<br />
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Patent ductus arteriosus]]<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Not at beginning<br />
* May be produced during the course of disease <br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Depends on the size<br />
| style="background: #F5F5F5; padding: 5px;" | -<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Continuous machine-like murmur<br />
| style="background: #F5F5F5; padding: 5px;" |-<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* May be present by progressing<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Golden standard <br />
* In color-Doppler visualization of flow through the patent duct which has a high velocity<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Non-specific<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Used for determining Krichenko classification<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Echocardiogram<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Krichenko criteria for classification is a very important factor for treatment<br />
|-<br />
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Aortic coarctation|Coarctation of the aorta]]<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/−<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/−<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Systolic murmur over the upper sternal border with radiation to the back<br />
*Murmur of mitral regurgitation (holosystolic murmur best heard at the apex)<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Narrowing of the aortic arch at the level of the isthmus<br />
* Left ventricular hypertrophy<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Notching of the posterior fourth to eighth ribs due to dilated intercostal arteries<br />
* Indentation of the aorta at the site of coarctation with pre- and post-stenotic dilation of the aorta (classic "3 sign")<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Dilation of the intercostal arteries<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Echocardiogram<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
*Patients present with arm-leg blood pressure gradient of >20mmHg<br />
|-<br />
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Aortic stenosis]]<br />
| style="background: #F5F5F5; padding: 5px;" |+<br />
| style="background: #F5F5F5; padding: 5px;" |+<br />
| style="background: #F5F5F5; padding: 5px;" |+<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Crescendo-decrescendo mid-systolic (or ejection systolic) murmur<br />
| style="background: #F5F5F5; padding: 5px;" |+/-<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Depending on severity<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Used for finding the location of stenosis<br />
* Finding severity<br />
* Evaluating the flow jet with color-Doppler ultrasound technique<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Non-specific at the beginning<br />
* At progressed stage calcification of the valve and cardiomegally<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
*[[Aortic calcification|Calcification score]]<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* MRI<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* MRI provides a more detailed structural and dynamic assessment of the aortic valve and left ventricle, in particular<br />
|-<br />
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Pulmonary valve stenosis|Pulmonary stenosis]]<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Depending on severity<br />
| style="background: #F5F5F5; padding: 5px;" | -<br />
| style="background: #F5F5F5; padding: 5px;" | -/+<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Continuous systolic murmur<br />
| style="background: #F5F5F5; padding: 5px;" |-<br />
| style="background: #F5F5F5; padding: 5px;" | -/+<br />
| style="background: #F5F5F5; padding: 5px;" | <br />
* Right atrial hypertrophy<br />
| style="background: #F5F5F5; padding: 5px;" | <br />
* Non-specific<br />
| style="background: #F5F5F5; padding: 5px;" | <br />
* Direct visualization of stenosis<br />
| style="background: #F5F5F5; padding: 5px;" | <br />
* Echocardiogram<br />
| style="background: #F5F5F5; padding: 5px;" | <br />
|}<br />
<br />
<br />
<br />
<br />
<br />
<br />
<br />
<br />
<br />
<br />
<br />
{| class="wikitable"<br />
|+<br />
!Diseases<br />
!Pathophysiology<br />
!Shunt<br />
!Symptoms<br />
!Diagnosis<br />
!Echocardiography findings<br />
!Physical examination<br />
!Treatment<br />
!Complications<br />
|-<br />
|Patent foramen ovale<br />
|<br />
* Failure of fusion of the septum primum and septum secundum leading to a flap valve opening.<br />
|<br />
* Right-to-left shunt<br />
<br />
* More prominent with increased right atrial pressure.<br />
|<br />
* Majority of patients are asymptomatic<br />
|<br />
* TEE (Gold standard)<br />
<br />
* TTE<br />
<br />
* TCD<br />
|<br />
* Appearance of at least 3 micro-bubbles in the left atrium within three cardiac cycles after the complete opacification of the right atrium<br />
|<br />
|<br />
* Percutaneous closure<br />
* Anticoagulants<br />
* Antiplatelets<br />
|<br />
* Paradoxical embolism<br />
<br />
* Migraine with aura<br />
*Decompression sickness in divers<br />
*Platypnea-orthodeoxia syndrome<br /><br />
|-<br />
|Atrial septal defect<br />
|<br />
* '''Ostium secundum defect''': Failure of the septum secundum to occlude the ostium secundum.<br />
<br />
* '''Ostium primum defect''': Failure of the ostium primum to fuse with the endocardial cushions.<br />
<br />
* '''Superior sinus venosus defect''': The orifice of the superior vena cava overrides the atrial septum above the fossa ovalis.<br />
<br />
* '''Inferior sinus venosus defect''': The orifice of the inferior vena cava overrides the left and right atrium.<br />
*'''Coronary sinus defect''': Absence of a portion of the common wall that separates the coronary sinus and the left atrium.<br />
|<br />
* Continuous left-to-right shunt<br />
|<br />
* Failure to thrive, tachypnea, recurrent respiratory infections, heart failure<br />
<br />
* Commonly asymptomatic during childhood and adolescence<br />
*Adults with large shunts may become symptomatic in the fourth decade presenting with fatigue, exercise intolerance, palpitations, syncope, and shortness of breath.<br />
<br />
*<br />
|<br />
* TTE (Gold standard)<br />
*Cardiac CT<br />
*Cardiac MRI<br />
|<br />
* Hypermobile interatrial septum<br />
* Abrupt septal irregularity<br />
* Right atrial and ventricular volume overload<br />
* Pulmonary artery dilation<br />
*'''Coronary sinus defect''': Enlarged ostium of the coronary sinus and unroofing of the terminal portion of the coronary sinus<br />
|<br />
* Systolic flow murmur in the pulmonary valve region<br />
*Wide, fixed splitting of S2<br />
*Diastolic flow rumble across the tricuspid valve<br />
*Right ventricular heave <br />
|<br />
* Spontaneous closure<br />
*Percutaneous transcatheter closure<br />
*Surgical closure<br />
|<br />
* Right sided heart failure<br />
* Peripheral edema<br />
* Eisenmenger syndrome (cyanosis)<br />
* Paradoxical emboli<br />
* Pulmonary hypertension<br />
|-<br />
|Pulmonary ateriovenous fistula<br />
|<br />
* Abnormal blood vessel(s) connecting the pulmonary arteries and veins directly without interposition of pulmonary capillaries<br />
|<br />
* Right-to-left shunt between the pulmonary artery and pulmonary vein<br />
|<br />
* Symptoms may occur only after the second decade<br />
*Cyanosis<br />
*Hemoptysis<br />
|<br />
* Chest CT<br />
*Pulmonary arteriogram<br />
|<br />
* Appearance of contrast bubbles in the left atrium three to five cardiac cycles after appearance in the right atrium<br />
|<br />
* Clubbing<br />
*Systolic/continuous murmur<br />
|<br />
* Embolization<br />
* Surgical resection<br />
|<br />
* Cerebral ischemia/abscess<br />
*Hemothorax<br />
|}<br />
<br />
==Differential table for aortic stenosis==<br />
<br />
{| class="wikitable"<br />
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;|Diseases<br />
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;|History<br />
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;|Symptoms<br />
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;|Physical Examination<br />
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;|Murmur<br />
! colspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;|Diagnosis<br />
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;|Other Findings<br />
|- style="background: #DCDCDC; padding: 5px; text-align: center;"<br />
!style="background: #4479BA; color: #FFFFFF; text-align: center;|ECG<br />
!style="background: #4479BA; color: #FFFFFF; text-align: center;|CXR<br />
!style="background: #4479BA; color: #FFFFFF; text-align: center;|Echocardiogram<br />
!style="background: #4479BA; color: #FFFFFF; text-align: center;|Cardiac Catheterization<br />
|-<br />
|style="background: #DCDCDC; padding: 5px; text-align: center;" |Aortic stenosis<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Age (aortic valve calcification)<br />
*Syncope<br />
*Orthopnea<br />
*Paroxysmal nocturnal dyspnea<br />
*Acute rheumatic fever<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Chest pain<br />
*Dyspnea on exertion<br />
*Palpitations<br />
*Symptoms of heart failure<br />
| style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Pulsus parvus et tardus<br />
*Pulmonary rales<br />
*Peripheral edema (In CHF patients)<br />
*Jugular venous distension<br />
*Enlarged and laterally displaced point of maximal impulse<br />
<br />
*<br />
| style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Crescendo-decrescendo systolic murmur<br />
*Best heard at the right upper sternal border<br />
*Radiation to the carotid arteries<br />
*Increases with squatting<br />
*Decreases with valsalva maneuver<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Left ventricular hypertrophy''':<br />
<br />
* Wide QRS complex (especially in leads V1-V6)<br />
*ST depression in leads V5-V6<br />
*Left axis deviation<br />
* <br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Enlarged left ventricle<br />
* Enlarged left atrium and pulmonary artery in severe cases<br />
*Calcification of the aortic valve<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Thickening and calcification of the aortic valve<br />
*Left ventricular hypertrophy<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Left heart catheterization:'''<br />
<br />
* Left ventricular and aortic pressures<br />
*The left ventricle generates higher pressures than what is transmitted to the aorta<br />
| style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Associated with von Willibrand disease<br />
|-<br />
| colspan="10" |<br />
|-<br />
|style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Mitral Stenosis]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Age ( Mitral annular calcification in older patients)<br />
<br />
* [[Rheumatic fever]]<br />
<br />
* [[Endocarditis]]<br />
<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* [[Dyspnea on exertion]]<br />
<br />
* [[Paroxysmal nocturnal dyspnea]]<br />
<br />
* [[Orthopnea]]<br />
<br />
* New onset [[atrial fibrillation]]<br />
<br />
| style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Mitral facies<br />
<br />
* Heart murmur<br />
<br />
* [[JVD|Jugular vein distension]]<br />
<br />
* Apical impulse displaced laterally or not palpable <br />
<br />
* Diastolic thrill at the apex <br />
<br />
* Signs of heart failure in severe cases<br />
| style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Diastolic murmur<br />
<br />
* Low pitched<br />
<br />
* Opening snap followed by decrescendo-crescendo rumbling murmur <br />
<br />
* Best heard with the bell of the stethoscope at apex at end-expiration in left lateral decubitus position <br />
<br />
* Intensity increases after a [[valsalva maneuver]], after exercise and after increased after load (eg., squatting, isometric hand grip) <br />
| style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* [[P mitrale]]<br />
* [[Atrial fibrillation]]: No P waves and irregularly irregular rhythm<br />
<br />
* [[Right axis deviation]]<br />
<br />
* Right ventricular hypertropy: Dominant R wave in V1 and V2<br />
| style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Straightening of the left border of the heart suggestive of enlargement of the [[left atrium]]<br />
<br />
* Double right heart border (Enlarged left atrium and normal right atrium) <br />
<br />
* Prominent left atrial appendage<br />
<br />
* Splaying of [[carina|subcarinal angle]] (>120 degrees)<br />
<br />
* Calcification of [[mitral valve]]<br />
<br />
* [[Kerley B lines]] <br />
<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Reduced valve leaflet mobility<br />
<br />
* Valve calcification <br />
<br />
* Doming of mitral valve<br />
<br />
* Valve thickening <br />
* Enlargement of left atrium <br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Right heart catheterization:'''<br />
* [[Pulmonary capillary wedge pressure]] (left atrial pressure) <br />
'''Left heart catheterization:'''<br />
* Pressures in left ventricle<br />
<br />
* Determines the gradient between the left and right atrium during ventricular diastole (marker of the severity of mitral stenosis)<br />
<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* [[Hemoptysis]] ([[heart failure]])<br />
<br />
* [[Ortner's syndrome]]<br />
|-<br />
| colspan="10" |<br />
|-<br />
|style="vertical-align: top;background: #DCDCDC; padding: 5px; text-align: center;" |[[Mitral Regurgitation]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* [[CAD]]<br />
<br />
* [[MI]]<br />
<br />
* [[Rheumatic fever]]<br />
<br />
* [[Endocarditis]]<br />
<br />
* [[Mitral valve prolapse]]<br />
<br />
* [[Cardiomyopathy]]<br />
<br />
* [[Radiation therapy]]<br />
<br />
* Trauma<br />
<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* [[Palpitations]]<br />
<br />
* Symptoms of heart failure in severe cases<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Palpation'''<br />
* Brisk carotid upstroke and hyperdymanic carotid impulse on palpation<br />
<br />
* Apical impulse is displaced to left<br />
<br />
* S3 and a palpable thrill<br />
'''Auscultation'''<br />
* Murmur<br />
<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* [[Holosystolic murmur]]<br />
<br />
* High pitched, blowing<br />
<br />
* Radiates to axilla<br />
<br />
* Best heard with the diaphragm of the stethoscope at apex in left lateral [[decubitus]] position<br />
<br />
* Intensity increases with hand grip or squatting <br />
<br />
* Decrease in intensity on standing or [[valsalva maneuver]] <br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* [[P mitrale]] in lead II<br />
* Increased QRS voltage<br />
* [[Right axis deviation]]<br />
* [[Atrial fibrillation]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Acute MR'''<br />
* [[Kerley B lines]]<br />
* No enlargement of cardiac silhouette<br />
'''Chronic MR'''<br />
* Enlarged cardiac silhouette<br />
* Straightening of left heart border<br />
* Splaying of subcarinal angle<br />
* Calcification of mitral annulus<br />
* Double right heart border<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Enlargement of left atrium and ventricle<br />
* Identify valve abnormality<br />
* Valve calcification<br />
* Severity of regurgitation<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Grading of MR is done with left ventriculography<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Decompensated and acute MR may lead to [[heart failure]]<br />
|-<br />
| colspan="10" |<br />
|-<br />
|style="vertical-align: top;background: #DCDCDC; padding: 5px; text-align: center;" |[[Atrial septal defect]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Frequent respiratory or lung infections<br />
* [[Dyspnea]]<br />
* Tiring when feeding (Infants)<br />
* Shortness of breath on exertion<br />
* [[Palpitations]]<br />
* Swelling of feet<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* [[Shortness of breath]]<br />
* [[Fatigue]]<br />
* [[Failure to thrive]]<br />
* Swelling of feet and abdomen ([[Right heart failure]])<br />
* [[Palpitations]]<br />
* Respiratory infections<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Inspection'''<br />
* Precordial bulge<br />
* Precordial lift<br />
'''Palpation'''<br />
* Right ventricular impulse<br />
* Pulmonary artery pulsations<br />
* Thrill<br />
'''Auscultation'''<br />
* Murmur<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Midsystolic (ejection systolic) murmur<br />
<br />
* Widely split, fixed S2<br />
<br />
* Upper left sternal border<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Normal <br />
* Prolonged PR interval<br />
* [[Right bundle branch block]]<br />
* ECG findings varies according to the underlying type of ASD<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
*Increased pulmonary markings<br />
*[[Cardiomegaly]]<br />
*Triangular appearance of heart<br />
*Schimitar sign<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Gold standard test for diagnosis of atrial septal defect (for more information click [[Atrial septal defect echocardiography]])<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Defect size<br />
* Pulmonary venous return<br />
* [[Pulmonary vascular resistance]]<br />
* [[Pulmonary artery hypertension]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Asymptomatic until later part of their life<br />
* May be associated with [[migraine with aura]]<br />
|-<br />
| colspan="10" |<br />
|-<br />
|style="vertical-align: top;background: #DCDCDC; padding: 5px; text-align: center;" |[[Atrial myxoma|Left Atrial Myxoma]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* [[Dyspnea]]<br />
* [[Orthopnea]]<br />
* [[Pulmonary edema]]<br />
* Hyperpigmentation of skin and endocrine activity<br />
* Cerebral [[embolism]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Symptoms may mimic mitral stenosis<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Skin'''<br />
* Signs of an embolic phenomenon<br />
* [[Raynaud's phenomenon]]<br />
* Swelling<br />
* Clubbing<br />
'''Auscultation:'''<br />
* Lung: Fine crepitations <br />
<br />
* Heart: Characteristic "tumor plop" <br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Early diastolic sound as "tumor plop"<br />
<br />
* Low frequency diastolic murmur may be heard if the tumor obstructing mitral valve <br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Often normal<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Often normal<br />
'''Rare findings:'''<br />
* [[cardiomegaly]]<br />
* Left atrial enlargement<br />
* tumor calcification etc.,<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Initial and most useful diagnostic study<br />
* For more information click [[Myxoma echocardiography or ultrasound]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Useful to detect vascular supply of the tumor by the coronary arteries <br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Associated with Carney complex (genetic predisposition)<br />
|-<br />
| colspan="10" |<br />
|-<br />
|style="vertical-align: top;background: #DCDCDC; padding: 5px; text-align: center;" |Prosthetic Valve Obstruction<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* History of valve replacement<br />
* Systemic embolism<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Shortness of breath<br />
* Fatigue<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Ausculation'''<br />
<br />
Muffling of murmur<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Muffling or disappearance of prosthetic sounds<br />
<br />
* Appearance of new regurgitant or obstructive murmur <br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Degree of stenosis<br />
* Assess thrombus size and location<br />
* Differentiate between thrombus, [[pannus]] and vegetations<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |Causes:<br />
* Thrombus<br />
* Pannus formation<br />
|-<br />
| colspan="10" |<br />
|-<br />
|style="vertical-align: top;background: #DCDCDC; padding: 5px; text-align: center;" |[[Cor Triatriatum]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Dyspnea on exertion <br />
* Recent onset of [[congestive heart failure]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Dsypnea on exertion<br />
* Orthopnea<br />
* Tachypnea<br />
* Palpitations<br />
* Growth failure<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Auscultation'''<br />
* Murmur<br />
'''Other findings'''<br />
* Signs of heart failure<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Diastolic murmur with loud P2<br />
<br />
* No opening snap or a loud S1<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |Non specific but may have<br />
* [[Right axis deviation]]<br />
* Right atrial enlargement<br />
* [[Right ventricular hypertrophy]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Normal cardiac silhouette<br />
* Hemodynamic changes similar to mitral stenosis (non specific findings)<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Direct visualization of membrane through the atrium<br />
* +/- visualization of accessory chamber<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Normal left ventricular hemodynamic profile with a trans atrial gradient<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |Types<br />
* Cor triatriatum sinistrum<br />
* Cor triatriatum dextrum<br />
|-<br />
| colspan="10" |<br />
|-<br />
|style="vertical-align: top;background: #DCDCDC; padding: 5px; text-align: center;" |Congenital Mitral Stenosis<br />
| style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Respiratory distress shortly after birth<br />
* Recurrent severe pulmonary infections<br />
* Other associated congenital cardiovascular anamolies<br />
* [[Atrial fibrillation]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
<br />
'''Infants:'''<br />
* Exhaustion and sweating on feeding<br />
* Rapid breathing<br />
* [[Failure to thrive]]<br />
* Pulmonary infections <br />
* Chronic cough<br />
'''Older patients:'''<br />
* Dyspnea<br />
* Orthopnea<br />
* Paroxysmal nocturnal dyspnea<br />
* Peripheral edema<br />
* Fatigue<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Auscultation'''<br />
* Murmur<br />
'''Other findings'''<br />
* Signs of heart failure<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Mild-Moderate'''<br />
* Loud S1<br />
<br />
* Loud P2<br />
<br />
* Low frequency diastolic murmur best heard at the apex <br />
'''Severe'''<br />
* Soft S1<br />
<br />
* Loud pulmonic component of S2 with minimal respiratory splitting of S2 <br />
<br />
* Holodiastolic murmur with presystolic accentuation best heard at the apex <br />
<br />
* Early diastolic murmur of pulmonic valve regurgitation <br />
<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
*Sharp P waves in leads I and II<br />
*Inversion of P wave in lead III<br />
*Marked Q waves in leads II and III<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Left atrial dilation<br />
* Moderate enlargement of right heart<br />
* Pulmonary venous congestion<br />
* Esophageal compression<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Reduced valve leaflet mobility<br />
* Left atrial size<br />
* Severity of mitral stenosis<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |Very rare condition<br />
|-<br />
| colspan="10" |<br />
|-<br />
|style="vertical-align: top;background: #DCDCDC; padding: 5px; text-align: center;" |Supravalvular Ring Mitral Stenosis<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Other associated congenital heart defects<br />
* Fatigue<br />
* Frequent respiratory infections<br />
* Failure to thrive<br />
* Poor feeding<br />
* Precocious congestive heart failure <br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Shortness of breath<br />
<br />
* Tachypnea<br />
* Dyspnea<br />
* Nocturnal cough<br />
* Heamoptysis<br />
* [[Syncope]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Auscultation:'''<br />
<br />
Lungs: Fine, crepitant rales and rhonchi or wheezes may be present<br />
<br />
Heart: Murmur<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* An apical mid diastolic murmur with presystolic accentuation<br />
<br />
* No opening snap<br />
<br />
* The murmur is more prominent if associated with [[VSD]] or [[PDA]]<br />
<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Left atrial and ventricular enlargement<br />
* Alveolar edema <br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Supramitral ring''':<br />
* Associated with normal mitral valve apparatus<br />
'''Intramitral ring:'''<br />
* Hypomobility of the posterior leaflet<br />
* Reduced interpapillary muscle distance<br />
* Reduced chordal length<br />
* Dominant papillary muscle<br />
* Hypoplastic mitral annulus<br />
(Difficult to visualize membrane <1mm in size)<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Persistently elevated pulmonary venous pressures<br />
* Increased pulmonary artery pressure<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Types'''<br />
* Supramitral<br />
* Intramitral<br />
It is attached between the opening of the atrial appendage and the mitral annulus which helps in differentiating with Cor triatriatum sinister.<br />
* Intramitral type is associated with shone complex<br />
|}</div>
Ifeoma odukwe
https://www.wikidoc.org/index.php?title=Sandbox:_Ifeoma&diff=1608386
Sandbox: Ifeoma
2020-05-16T00:07:50Z
<p>Ifeoma odukwe: </p>
<hr />
<div>: A colon indents a line or paragraph<br />
<br />
<blockquote><br />
'''A colon indents a line or paragraph'''<br />
</blockquote><br />
<br />
<center>Centered text <br />
</center><br />
<br />
<br />
<br />
<br />
==Classification of dextrocardia==<br />
{| style="border: 0px; font-size: 90%; margin: 3px; width: 1000px"<br />
|valign=top|<br />
|+<br />
! style="background: #4479BA; width: 250px; color: #FFFFFF;"|'''Dextrocardia Types'''<br />
<br />
! style="background: #4479BA; width: 600px; color: #FFFFFF;"|'''Description'''<br />
<br />
|-<br />
<br />
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align=center | '''Dextrocardia with situs solitus '''|| style="padding: 5px 5px; background: #F5F5F5;" |<br />
:* Dextrocardia with normally related great arteries and D-transposition (complete transposition) or L-transposition (congenitally corrected transposition) of the great arteries. Some examples include dextrocardia with D-loop ventricles and normally related great arteries, with L-loop ventricles and L-TGA (congenitally corrected TGA).<br />
:* Embryologic failure of the final leftward shift of the ventricles during development results in dextrocardia with situs solitus, D-loop ventricles, and normally related great arteries.<br />
<br />
|-<br />
<br />
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align=center | '''Dextrocardia with situs inversus '''|| style="padding: 5px 5px; background: #F5F5F5;"|<br />
:* May present with dextrocardia with inversely related great arteries and D-transposition (congenitally corrected transposition) or L-transposition (“uncorrected” transposition) of the great arteries. An example is dextrocardia with D-loop ventricles and D-TGA (congenitally corrected TGA).<br />
<br />
|-<br />
<br />
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align=center | '''Dextrocardia with situs ambiguous (either polyspenia or asplenia)''' || style="padding: 5px 5px; background: #F5F5F5;"|<br />
:* Dextrocardia with any of the above relationships between the ventricles and great vessels.<br />
<br />
|-<br />
<br />
<br />
{|<br />
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"<br />
! rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;|Diseases<br />
| colspan="6" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;|'''Clinical manifestations'''<br />
! colspan="3" rowspan="2" |Para-clinical findings<br />
| colspan="1" rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;|'''Gold standard'''<br />
! rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;|Additional findings<br />
|-<br />
| colspan="3" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;|'''Symptoms'''<br />
! colspan="3" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;|Physical examination<br />
|-<br />
! colspan="3" style="background: #4479BA; color: #FFFFFF; text-align: center;|Imaging<br />
|- <br />
! style="background: #4479BA; color: #FFFFFF; text-align: center;|Exertional dyspnea<br />
! colspan="1" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;|Failure to thrive<br />
! style="background: #4479BA; color: #FFFFFF; text-align: center;|Recurrent respiratory infections<br />
! style="background: #4479BA; color: #FFFFFF; text-align: center;|Murmur on auscultation<br />
! colspan="1" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;|Peripheral edema<br />
! style="background: #4479BA; color: #FFFFFF; text-align: center;|Clubbing<br />
! style="background: #4479BA; color: #FFFFFF; text-align: center;|Echocardiography<br />
! style="background: #4479BA; color: #FFFFFF; text-align: center;|Chest x-ray<br />
! style="background: #4479BA; color: #FFFFFF; text-align: center;|Cardiac CT<br />
|-<br />
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Patent foramen ovale]]<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Appearance of at least 3 micro-bubbles in the left atrium within three cardiac cycles after complete opacification of the right atrium<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | Non specific<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | <br />
* A contrast agent jet from the left atrium to the right atrium toward the inferior vena cava with channel-like appearance of the interatrial septum<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Echocardiogram<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* It is associated with paradoxical embolism, migraine headache, and decompression sickness in divers<br />
|-<br />
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Atrial septal defect]]<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/−<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/−<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/− <br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Systolic flow murmur in the upper left sternal border<br />
* Wide, fixed splitting of S2<br />
* Diastolic flow rumble across the tricuspid valve<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/−<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/−<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Hypermobile interatrial septum<br />
* Abrupt septal irregularity<br />
* Right atrial and ventricular volume overload<br />
* Pulmonary artery dilatation<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Cardiomegaly <br />
* Pulmonary artery enlargement/increased pulmonary vascularity<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Enlargement of the right atrium and ventricle<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Echocardiogram<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Atrial septal defect is classified into 5 types including ostium primum defect, ostium secundum defect, superior sinus venosus defect, inferior sinus venosus defect, and coronary sinus defect<br />
|-<br />
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Ventricular septal defect]]<br />
| style="background: #F5F5F5; padding: 5px;" |-/+<br />
| style="background: #F5F5F5; padding: 5px;" |-/+<br />
| style="background: #F5F5F5; padding: 5px;" |After Eisenmenger syndrome<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Holosystolic murmur<br />
* May mimic aortic stenosis(mid/end dyastolic murmur due to increased pulmonary circulation)<br />
| style="background: #F5F5F5; padding: 5px;" |-/+<br />
| style="background: #F5F5F5; padding: 5px;" |-/+<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Defect localization<br />
*septal dropout in the area adjacent to the tricuspid septal leaflet and below the right border of the aortic annulus<br />
* Direction of jet<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* [[Cardiomegaly]] in large VSD<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Direct visualisation of murmur<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Echocardiogram<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"<br />
!Diseases<br />
!Exertional dyspnea<br />
! colspan="1" rowspan="1" |Failure to thrive<br />
!Recurrent respiratory infections<br />
!Murmur on auscultation<br />
! colspan="1" rowspan="1" |Peripheral edema<br />
!Clubbing<br />
!Echocardiography<br />
!Chest x-ray<br />
!Cardiac CT<br />
|'''Gold standard'''<br />
!Additional findings<br />
|-<br />
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Patent ductus arteriosus]]<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Not at beginning<br />
* May be produced during the course of disease <br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Depends on the size<br />
| style="background: #F5F5F5; padding: 5px;" | -<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Continuous machine-like murmur<br />
| style="background: #F5F5F5; padding: 5px;" |-<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* May be present by progressing<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Golden standard <br />
* In color-Doppler visualization of flow through the patent duct which has a high velocity<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Non-specific<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Used for determining Krichenko classification<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Echocardiogram<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Krichenko criteria for classification is a very important factor for treatment<br />
|-<br />
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Aortic coarctation|Coarctation of the aorta]]<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/−<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/−<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Systolic murmur over the upper sternal border with radiation to the back<br />
*Murmur of mitral regurgitation (holosystolic murmur best heard at the apex)<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Narrowing of the aortic arch at the level of the isthmus<br />
* Left ventricular hypertrophy<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Notching of the posterior fourth to eighth ribs due to dilated intercostal arteries<br />
* Indentation of the aorta at the site of coarctation with pre- and post-stenotic dilation of the aorta (classic "3 sign")<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Dilation of the intercostal arteries<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Echocardiogram<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
*Patients present with arm-leg blood pressure gradient of >20mmHg<br />
|-<br />
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Aortic stenosis]]<br />
| style="background: #F5F5F5; padding: 5px;" |+<br />
| style="background: #F5F5F5; padding: 5px;" |+<br />
| style="background: #F5F5F5; padding: 5px;" |+<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Crescendo-decrescendo mid-systolic (or ejection systolic) murmur<br />
| style="background: #F5F5F5; padding: 5px;" |+/-<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Depending on severity<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Used for finding the location of stenosis<br />
* Finding severity<br />
* Evaluating the flow jet with color-Doppler ultrasound technique<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Non-specific at the beginning<br />
* At progressed stage calcification of the valve and cardiomegally<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
*[[Aortic calcification|Calcification score]]<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* MRI<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* MRI provides a more detailed structural and dynamic assessment of the aortic valve and left ventricle, in particular<br />
|-<br />
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Pulmonary valve stenosis|Pulmonary stenosis]]<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Depending on severity<br />
| style="background: #F5F5F5; padding: 5px;" | -<br />
| style="background: #F5F5F5; padding: 5px;" | -/+<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Continuous systolic murmur<br />
| style="background: #F5F5F5; padding: 5px;" |-<br />
| style="background: #F5F5F5; padding: 5px;" | -/+<br />
| style="background: #F5F5F5; padding: 5px;" | <br />
* Right atrial hypertrophy<br />
| style="background: #F5F5F5; padding: 5px;" | <br />
* Non-specific<br />
| style="background: #F5F5F5; padding: 5px;" | <br />
* Direct visualization of stenosis<br />
| style="background: #F5F5F5; padding: 5px;" | <br />
* Echocardiogram<br />
| style="background: #F5F5F5; padding: 5px;" | <br />
|}<br />
<br />
<br />
<br />
<br />
<br />
<br />
<br />
<br />
<br />
<br />
<br />
{| class="wikitable"<br />
|+<br />
!Diseases<br />
!Pathophysiology<br />
!Shunt<br />
!Symptoms<br />
!Diagnosis<br />
!Echocardiography findings<br />
!Physical examination<br />
!Treatment<br />
!Complications<br />
|-<br />
|Patent foramen ovale<br />
|<br />
* Failure of fusion of the septum primum and septum secundum leading to a flap valve opening.<br />
|<br />
* Right-to-left shunt<br />
<br />
* More prominent with increased right atrial pressure.<br />
|<br />
* Majority of patients are asymptomatic<br />
|<br />
* TEE (Gold standard)<br />
<br />
* TTE<br />
<br />
* TCD<br />
|<br />
* Appearance of at least 3 micro-bubbles in the left atrium within three cardiac cycles after the complete opacification of the right atrium<br />
|<br />
|<br />
* Percutaneous closure<br />
* Anticoagulants<br />
* Antiplatelets<br />
|<br />
* Paradoxical embolism<br />
<br />
* Migraine with aura<br />
*Decompression sickness in divers<br />
*Platypnea-orthodeoxia syndrome<br /><br />
|-<br />
|Atrial septal defect<br />
|<br />
* '''Ostium secundum defect''': Failure of the septum secundum to occlude the ostium secundum.<br />
<br />
* '''Ostium primum defect''': Failure of the ostium primum to fuse with the endocardial cushions.<br />
<br />
* '''Superior sinus venosus defect''': The orifice of the superior vena cava overrides the atrial septum above the fossa ovalis.<br />
<br />
* '''Inferior sinus venosus defect''': The orifice of the inferior vena cava overrides the left and right atrium.<br />
*'''Coronary sinus defect''': Absence of a portion of the common wall that separates the coronary sinus and the left atrium.<br />
|<br />
* Continuous left-to-right shunt<br />
|<br />
* Failure to thrive, tachypnea, recurrent respiratory infections, heart failure<br />
<br />
* Commonly asymptomatic during childhood and adolescence<br />
*Adults with large shunts may become symptomatic in the fourth decade presenting with fatigue, exercise intolerance, palpitations, syncope, and shortness of breath.<br />
<br />
*<br />
|<br />
* TTE (Gold standard)<br />
*Cardiac CT<br />
*Cardiac MRI<br />
|<br />
* Hypermobile interatrial septum<br />
* Abrupt septal irregularity<br />
* Right atrial and ventricular volume overload<br />
* Pulmonary artery dilation<br />
*'''Coronary sinus defect''': Enlarged ostium of the coronary sinus and unroofing of the terminal portion of the coronary sinus<br />
|<br />
* Systolic flow murmur in the pulmonary valve region<br />
*Wide, fixed splitting of S2<br />
*Diastolic flow rumble across the tricuspid valve<br />
*Right ventricular heave <br />
|<br />
* Spontaneous closure<br />
*Percutaneous transcatheter closure<br />
*Surgical closure<br />
|<br />
* Right sided heart failure<br />
* Peripheral edema<br />
* Eisenmenger syndrome (cyanosis)<br />
* Paradoxical emboli<br />
* Pulmonary hypertension<br />
|-<br />
|Pulmonary ateriovenous fistula<br />
|<br />
* Abnormal blood vessel(s) connecting the pulmonary arteries and veins directly without interposition of pulmonary capillaries<br />
|<br />
* Right-to-left shunt between the pulmonary artery and pulmonary vein<br />
|<br />
* Symptoms may occur only after the second decade<br />
*Cyanosis<br />
*Hemoptysis<br />
|<br />
* Chest CT<br />
*Pulmonary arteriogram<br />
|<br />
* Appearance of contrast bubbles in the left atrium three to five cardiac cycles after appearance in the right atrium<br />
|<br />
* Clubbing<br />
*Systolic/continuous murmur<br />
|<br />
* Embolization<br />
* Surgical resection<br />
|<br />
* Cerebral ischemia/abscess<br />
*Hemothorax<br />
|}<br />
<br />
==Differential table for aortic stenosis==<br />
<br />
{| class="wikitable"<br />
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;|Diseases<br />
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;|History<br />
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;|Symptoms<br />
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;|Physical Examination<br />
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;|Murmur<br />
! colspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;|Diagnosis<br />
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;|Other Findings<br />
|- style="background: #DCDCDC; padding: 5px; text-align: center;"<br />
!style="background: #4479BA; color: #FFFFFF; text-align: center;|ECG<br />
!style="background: #4479BA; color: #FFFFFF; text-align: center;|CXR<br />
!style="background: #4479BA; color: #FFFFFF; text-align: center;|Echocardiogram<br />
!style="background: #4479BA; color: #FFFFFF; text-align: center;|Cardiac Catheterization<br />
|-<br />
|style="background: #DCDCDC; padding: 5px; text-align: center;" |Aortic stenosis<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Age (aortic valve calcification)<br />
*Syncope<br />
*Orthopnea<br />
*Paroxysmal nocturnal dyspnea<br />
*Acute rheumatic fever<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Chest pain<br />
*Dyspnea on exertion<br />
*Palpitations<br />
*Symptoms of heart failure<br />
| style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Pulsus parvus et tardus<br />
*Pulmonary rales<br />
*Peripheral edema (In CHF patients)<br />
*Jugular venous distension<br />
*Enlarged and laterally displaced point of maximal impulse<br />
<br />
*<br />
| style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Crescendo-decrescendo systolic murmur<br />
*Best heard at the right upper sternal border<br />
*Radiation to the carotid arteries<br />
*Increases with squatting<br />
*Decreases with valsalva maneuver<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Left ventricular hypertrophy''':<br />
<br />
* Wide QRS complex (especially in leads V1-V6)<br />
*ST depression in leads V5-V6<br />
*Left axis deviation<br />
* <br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Enlarged left ventricle<br />
* Enlarged left atrium and pulmonary artery in severe cases<br />
*Calcification of the aortic valve<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Thickening and calcification of the aortic valve<br />
*Left ventricular hypertrophy<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Left heart catheterization:'''<br />
<br />
* Left ventricular and aortic pressures<br />
*The left ventricle generates higher pressures than what is transmitted to the aorta<br />
| style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Associated with von Willibrand disease<br />
|-<br />
| colspan="10" |<br />
|-<br />
|style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Mitral Stenosis]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Age ( Mitral annular calcification in older patients)<br />
<br />
* [[Rheumatic fever]]<br />
<br />
* [[Endocarditis]]<br />
<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* [[Dyspnea on exertion]]<br />
<br />
* [[Paroxysmal nocturnal dyspnea]]<br />
<br />
* [[Orthopnea]]<br />
<br />
* New onset [[atrial fibrillation]]<br />
<br />
| style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Mitral facies<br />
<br />
* Heart murmur<br />
<br />
* [[JVD|Jugular vein distension]]<br />
<br />
* Apical impulse displaced laterally or not palpable <br />
<br />
* Diastolic thrill at the apex <br />
<br />
* Signs of heart failure in severe cases<br />
| style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Diastolic murmur<br />
<br />
* Low pitched<br />
<br />
* Opening snap followed by decrescendo-crescendo rumbling murmur <br />
<br />
* Best heard with the bell of the stethoscope at apex at end-expiration in left lateral decubitus position <br />
<br />
* Intensity increases after a [[valsalva maneuver]], after exercise and after increased after load (eg., squatting, isometric hand grip) <br />
| style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* [[P mitrale]]<br />
* [[Atrial fibrillation]]: No P waves and irregularly irregular rhythm<br />
<br />
* [[Right axis deviation]]<br />
<br />
* Right ventricular hypertropy: Dominant R wave in V1 and V2<br />
| style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Straightening of the left border of the heart suggestive of enlargement of the [[left atrium]]<br />
<br />
* Double right heart border (Enlarged left atrium and normal right atrium) <br />
<br />
* Prominent left atrial appendage<br />
<br />
* Splaying of [[carina|subcarinal angle]] (>120 degrees)<br />
<br />
* Calcification of [[mitral valve]]<br />
<br />
* [[Kerley B lines]] <br />
<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Reduced valve leaflet mobility<br />
<br />
* Valve calcification <br />
<br />
* Doming of mitral valve<br />
<br />
* Valve thickening <br />
* Enlargement of left atrium <br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Right heart catheterization:'''<br />
* [[Pulmonary capillary wedge pressure]] (left atrial pressure) <br />
'''Left heart catheterization:'''<br />
* Pressures in left ventricle<br />
<br />
* Determines the gradient between the left and right atrium during ventricular diastole (marker of the severity of mitral stenosis)<br />
<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* [[Hemoptysis]] ([[heart failure]])<br />
<br />
* [[Ortner's syndrome]]<br />
|-<br />
| colspan="10" |<br />
|-<br />
|style="vertical-align: top;background: #DCDCDC; padding: 5px; text-align: center;" |[[Mitral Regurgitation]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* [[CAD]]<br />
<br />
* [[MI]]<br />
<br />
* [[Rheumatic fever]]<br />
<br />
* [[Endocarditis]]<br />
<br />
* [[Mitral valve prolapse]]<br />
<br />
* [[Cardiomyopathy]]<br />
<br />
* [[Radiation therapy]]<br />
<br />
* Trauma<br />
<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* [[Palpitations]]<br />
<br />
* Symptoms of heart failure in severe cases<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Palpation'''<br />
* Brisk carotid upstroke and hyperdymanic carotid impulse on palpation<br />
<br />
* Apical impulse is displaced to left<br />
<br />
* S3 and a palpable thrill<br />
'''Auscultation'''<br />
* Murmur<br />
<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* [[Holosystolic murmur]]<br />
<br />
* High pitched, blowing<br />
<br />
* Radiates to axilla<br />
<br />
* Best heard with the diaphragm of the stethoscope at apex in left lateral [[decubitus]] position<br />
<br />
* Intensity increases with hand grip or squatting <br />
<br />
* Decrease in intensity on standing or [[valsalva maneuver]] <br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* [[P mitrale]] in lead II<br />
* Increased QRS voltage<br />
* [[Right axis deviation]]<br />
* [[Atrial fibrillation]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Acute MR'''<br />
* [[Kerley B lines]]<br />
* No enlargement of cardiac silhouette<br />
'''Chronic MR'''<br />
* Enlarged cardiac silhouette<br />
* Straightening of left heart border<br />
* Splaying of subcarinal angle<br />
* Calcification of mitral annulus<br />
* Double right heart border<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Enlargement of left atrium and ventricle<br />
* Identify valve abnormality<br />
* Valve calcification<br />
* Severity of regurgitation<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Grading of MR is done with left ventriculography<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Decompensated and acute MR may lead to [[heart failure]]<br />
|-<br />
| colspan="10" |<br />
|-<br />
|style="vertical-align: top;background: #DCDCDC; padding: 5px; text-align: center;" |[[Atrial septal defect]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Frequent respiratory or lung infections<br />
* [[Dyspnea]]<br />
* Tiring when feeding (Infants)<br />
* Shortness of breath on exertion<br />
* [[Palpitations]]<br />
* Swelling of feet<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* [[Shortness of breath]]<br />
* [[Fatigue]]<br />
* [[Failure to thrive]]<br />
* Swelling of feet and abdomen ([[Right heart failure]])<br />
* [[Palpitations]]<br />
* Respiratory infections<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Inspection'''<br />
* Precordial bulge<br />
* Precordial lift<br />
'''Palpation'''<br />
* Right ventricular impulse<br />
* Pulmonary artery pulsations<br />
* Thrill<br />
'''Auscultation'''<br />
* Murmur<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Midsystolic (ejection systolic) murmur<br />
<br />
* Widely split, fixed S2<br />
<br />
* Upper left sternal border<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Normal <br />
* Prolonged PR interval<br />
* [[Right bundle branch block]]<br />
* ECG findings varies according to the underlying type of ASD<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
*Increased pulmonary markings<br />
*[[Cardiomegaly]]<br />
*Triangular appearance of heart<br />
*Schimitar sign<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Gold standard test for diagnosis of atrial septal defect (for more information click [[Atrial septal defect echocardiography]])<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Defect size<br />
* Pulmonary venous return<br />
* [[Pulmonary vascular resistance]]<br />
* [[Pulmonary artery hypertension]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Asymptomatic until later part of their life<br />
* May be associated with [[migraine with aura]]<br />
|-<br />
| colspan="10" |<br />
|-<br />
|style="vertical-align: top;background: #DCDCDC; padding: 5px; text-align: center;" |[[Atrial myxoma|Left Atrial Myxoma]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* [[Dyspnea]]<br />
* [[Orthopnea]]<br />
* [[Pulmonary edema]]<br />
* Hyperpigmentation of skin and endocrine activity<br />
* Cerebral [[embolism]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Symptoms may mimic mitral stenosis<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Skin'''<br />
* Signs of an embolic phenomenon<br />
* [[Raynaud's phenomenon]]<br />
* Swelling<br />
* Clubbing<br />
'''Auscultation:'''<br />
* Lung: Fine crepitations <br />
<br />
* Heart: Characteristic "tumor plop" <br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Early diastolic sound as "tumor plop"<br />
<br />
* Low frequency diastolic murmur may be heard if the tumor obstructing mitral valve <br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Often normal<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Often normal<br />
'''Rare findings:'''<br />
* [[cardiomegaly]]<br />
* Left atrial enlargement<br />
* tumor calcification etc.,<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Initial and most useful diagnostic study<br />
* For more information click [[Myxoma echocardiography or ultrasound]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Useful to detect vascular supply of the tumor by the coronary arteries <br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Associated with Carney complex (genetic predisposition)<br />
|-<br />
| colspan="10" |<br />
|-<br />
|style="vertical-align: top;background: #DCDCDC; padding: 5px; text-align: center;" |Prosthetic Valve Obstruction<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* History of valve replacement<br />
* Systemic embolism<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Shortness of breath<br />
* Fatigue<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Ausculation'''<br />
<br />
Muffling of murmur<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Muffling or disappearance of prosthetic sounds<br />
<br />
* Appearance of new regurgitant or obstructive murmur <br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Degree of stenosis<br />
* Assess thrombus size and location<br />
* Differentiate between thrombus, [[pannus]] and vegetations<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |Causes:<br />
* Thrombus<br />
* Pannus formation<br />
|-<br />
| colspan="10" |<br />
|-<br />
|style="vertical-align: top;background: #DCDCDC; padding: 5px; text-align: center;" |[[Cor Triatriatum]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Dyspnea on exertion <br />
* Recent onset of [[congestive heart failure]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Dsypnea on exertion<br />
* Orthopnea<br />
* Tachypnea<br />
* Palpitations<br />
* Growth failure<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Auscultation'''<br />
* Murmur<br />
'''Other findings'''<br />
* Signs of heart failure<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Diastolic murmur with loud P2<br />
<br />
* No opening snap or a loud S1<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |Non specific but may have<br />
* [[Right axis deviation]]<br />
* Right atrial enlargement<br />
* [[Right ventricular hypertrophy]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Normal cardiac silhouette<br />
* Hemodynamic changes similar to mitral stenosis (non specific findings)<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Direct visualization of membrane through the atrium<br />
* +/- visualization of accessory chamber<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Normal left ventricular hemodynamic profile with a trans atrial gradient<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |Types<br />
* Cor triatriatum sinistrum<br />
* Cor triatriatum dextrum<br />
|-<br />
| colspan="10" |<br />
|-<br />
|style="vertical-align: top;background: #DCDCDC; padding: 5px; text-align: center;" |Congenital Mitral Stenosis<br />
| style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Respiratory distress shortly after birth<br />
* Recurrent severe pulmonary infections<br />
* Other associated congenital cardiovascular anamolies<br />
* [[Atrial fibrillation]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
<br />
'''Infants:'''<br />
* Exhaustion and sweating on feeding<br />
* Rapid breathing<br />
* [[Failure to thrive]]<br />
* Pulmonary infections <br />
* Chronic cough<br />
'''Older patients:'''<br />
* Dyspnea<br />
* Orthopnea<br />
* Paroxysmal nocturnal dyspnea<br />
* Peripheral edema<br />
* Fatigue<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Auscultation'''<br />
* Murmur<br />
'''Other findings'''<br />
* Signs of heart failure<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Mild-Moderate'''<br />
* Loud S1<br />
<br />
* Loud P2<br />
<br />
* Low frequency diastolic murmur best heard at the apex <br />
'''Severe'''<br />
* Soft S1<br />
<br />
* Loud pulmonic component of S2 with minimal respiratory splitting of S2 <br />
<br />
* Holodiastolic murmur with presystolic accentuation best heard at the apex <br />
<br />
* Early diastolic murmur of pulmonic valve regurgitation <br />
<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
*Sharp P waves in leads I and II<br />
*Inversion of P wave in lead III<br />
*Marked Q waves in leads II and III<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Left atrial dilation<br />
* Moderate enlargement of right heart<br />
* Pulmonary venous congestion<br />
* Esophageal compression<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Reduced valve leaflet mobility<br />
* Left atrial size<br />
* Severity of mitral stenosis<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |Very rare condition<br />
|-<br />
| colspan="10" |<br />
|-<br />
|style="vertical-align: top;background: #DCDCDC; padding: 5px; text-align: center;" |Supravalvular Ring Mitral Stenosis<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Other associated congenital heart defects<br />
* Fatigue<br />
* Frequent respiratory infections<br />
* Failure to thrive<br />
* Poor feeding<br />
* Precocious congestive heart failure <br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Shortness of breath<br />
<br />
* Tachypnea<br />
* Dyspnea<br />
* Nocturnal cough<br />
* Heamoptysis<br />
* [[Syncope]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Auscultation:'''<br />
<br />
Lungs: Fine, crepitant rales and rhonchi or wheezes may be present<br />
<br />
Heart: Murmur<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* An apical mid diastolic murmur with presystolic accentuation<br />
<br />
* No opening snap<br />
<br />
* The murmur is more prominent if associated with [[VSD]] or [[PDA]]<br />
<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Left atrial and ventricular enlargement<br />
* Alveolar edema <br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Supramitral ring''':<br />
* Associated with normal mitral valve apparatus<br />
'''Intramitral ring:'''<br />
* Hypomobility of the posterior leaflet<br />
* Reduced interpapillary muscle distance<br />
* Reduced chordal length<br />
* Dominant papillary muscle<br />
* Hypoplastic mitral annulus<br />
(Difficult to visualize membrane <1mm in size)<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Persistently elevated pulmonary venous pressures<br />
* Increased pulmonary artery pressure<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Types'''<br />
* Supramitral<br />
* Intramitral<br />
It is attached between the opening of the atrial appendage and the mitral annulus which helps in differentiating with Cor triatriatum sinister.<br />
* Intramitral type is associated with shone complex<br />
|}</div>
Ifeoma odukwe
https://www.wikidoc.org/index.php?title=Sandbox:_Ifeoma&diff=1608385
Sandbox: Ifeoma
2020-05-15T23:59:28Z
<p>Ifeoma odukwe: </p>
<hr />
<div>: A colon indents a line or paragraph<br />
<br />
<blockquote><br />
'''A colon indents a line or paragraph'''<br />
</blockquote><br />
<br />
<br />
<br />
<br />
<br />
==Classification of dextrocardia==<br />
{| style="border: 0px; font-size: 90%; margin: 3px; width: 1000px"<br />
|valign=top|<br />
|+<br />
! style="background: #4479BA; width: 250px; color: #FFFFFF;"|'''Dextrocardia Types'''<br />
<br />
! style="background: #4479BA; width: 600px; color: #FFFFFF;"|'''Description'''<br />
<br />
|-<br />
<br />
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align=center | '''Dextrocardia with situs solitus '''|| style="padding: 5px 5px; background: #F5F5F5;" |<br />
:* Dextrocardia with normally related great arteries and D-transposition (complete transposition) or L-transposition (congenitally corrected transposition) of the great arteries. Some examples include dextrocardia with D-loop ventricles and normally related great arteries, with L-loop ventricles and L-TGA (congenitally corrected TGA).<br />
:* Embryologic failure of the final leftward shift of the ventricles during development results in dextrocardia with situs solitus, D-loop ventricles, and normally related great arteries.<br />
<br />
|-<br />
<br />
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align=center | '''Dextrocardia with situs inversus '''|| style="padding: 5px 5px; background: #F5F5F5;"|<br />
:* May present with dextrocardia with inversely related great arteries and D-transposition (congenitally corrected transposition) or L-transposition (“uncorrected” transposition) of the great arteries. An example is dextrocardia with D-loop ventricles and D-TGA (congenitally corrected TGA).<br />
<br />
|-<br />
<br />
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align=center | '''Dextrocardia with situs ambiguous (either polyspenia or asplenia)''' || style="padding: 5px 5px; background: #F5F5F5;"|<br />
:* Dextrocardia with any of the above relationships between the ventricles and great vessels.<br />
<br />
|-<br />
<br />
<br />
{|<br />
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"<br />
! rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;|Diseases<br />
| colspan="6" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;|'''Clinical manifestations'''<br />
! colspan="3" rowspan="2" |Para-clinical findings<br />
| colspan="1" rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;|'''Gold standard'''<br />
! rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;|Additional findings<br />
|-<br />
| colspan="3" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;|'''Symptoms'''<br />
! colspan="3" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;|Physical examination<br />
|-<br />
! colspan="3" style="background: #4479BA; color: #FFFFFF; text-align: center;|Imaging<br />
|- <br />
! style="background: #4479BA; color: #FFFFFF; text-align: center;|Exertional dyspnea<br />
! colspan="1" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;|Failure to thrive<br />
! style="background: #4479BA; color: #FFFFFF; text-align: center;|Recurrent respiratory infections<br />
! style="background: #4479BA; color: #FFFFFF; text-align: center;|Murmur on auscultation<br />
! colspan="1" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;|Peripheral edema<br />
! style="background: #4479BA; color: #FFFFFF; text-align: center;|Clubbing<br />
! style="background: #4479BA; color: #FFFFFF; text-align: center;|Echocardiography<br />
! style="background: #4479BA; color: #FFFFFF; text-align: center;|Chest x-ray<br />
! style="background: #4479BA; color: #FFFFFF; text-align: center;|Cardiac CT<br />
|-<br />
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Patent foramen ovale]]<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Appearance of at least 3 micro-bubbles in the left atrium within three cardiac cycles after complete opacification of the right atrium<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | Non specific<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | <br />
* A contrast agent jet from the left atrium to the right atrium toward the inferior vena cava with channel-like appearance of the interatrial septum<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Echocardiogram<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* It is associated with paradoxical embolism, migraine headache, and decompression sickness in divers<br />
|-<br />
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Atrial septal defect]]<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/−<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/−<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/− <br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Systolic flow murmur in the upper left sternal border<br />
* Wide, fixed splitting of S2<br />
* Diastolic flow rumble across the tricuspid valve<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/−<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/−<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Hypermobile interatrial septum<br />
* Abrupt septal irregularity<br />
* Right atrial and ventricular volume overload<br />
* Pulmonary artery dilatation<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Cardiomegaly <br />
* Pulmonary artery enlargement/increased pulmonary vascularity<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Enlargement of the right atrium and ventricle<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Echocardiogram<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Atrial septal defect is classified into 5 types including ostium primum defect, ostium secundum defect, superior sinus venosus defect, inferior sinus venosus defect, and coronary sinus defect<br />
|-<br />
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Ventricular septal defect]]<br />
| style="background: #F5F5F5; padding: 5px;" |-/+<br />
| style="background: #F5F5F5; padding: 5px;" |-/+<br />
| style="background: #F5F5F5; padding: 5px;" |After Eisenmenger syndrome<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Holosystolic murmur<br />
* May mimic aortic stenosis(mid/end dyastolic murmur due to increased pulmonary circulation)<br />
| style="background: #F5F5F5; padding: 5px;" |-/+<br />
| style="background: #F5F5F5; padding: 5px;" |-/+<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Defect localization<br />
*septal dropout in the area adjacent to the tricuspid septal leaflet and below the right border of the aortic annulus<br />
* Direction of jet<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* [[Cardiomegaly]] in large VSD<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Direct visualisation of murmur<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Echocardiogram<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"<br />
!Diseases<br />
!Exertional dyspnea<br />
! colspan="1" rowspan="1" |Failure to thrive<br />
!Recurrent respiratory infections<br />
!Murmur on auscultation<br />
! colspan="1" rowspan="1" |Peripheral edema<br />
!Clubbing<br />
!Echocardiography<br />
!Chest x-ray<br />
!Cardiac CT<br />
|'''Gold standard'''<br />
!Additional findings<br />
|-<br />
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Patent ductus arteriosus]]<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Not at beginning<br />
* May be produced during the course of disease <br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Depends on the size<br />
| style="background: #F5F5F5; padding: 5px;" | -<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Continuous machine-like murmur<br />
| style="background: #F5F5F5; padding: 5px;" |-<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* May be present by progressing<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Golden standard <br />
* In color-Doppler visualization of flow through the patent duct which has a high velocity<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Non-specific<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Used for determining Krichenko classification<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Echocardiogram<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Krichenko criteria for classification is a very important factor for treatment<br />
|-<br />
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Aortic coarctation|Coarctation of the aorta]]<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/−<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/−<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Systolic murmur over the upper sternal border with radiation to the back<br />
*Murmur of mitral regurgitation (holosystolic murmur best heard at the apex)<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Narrowing of the aortic arch at the level of the isthmus<br />
* Left ventricular hypertrophy<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Notching of the posterior fourth to eighth ribs due to dilated intercostal arteries<br />
* Indentation of the aorta at the site of coarctation with pre- and post-stenotic dilation of the aorta (classic "3 sign")<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Dilation of the intercostal arteries<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Echocardiogram<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
*Patients present with arm-leg blood pressure gradient of >20mmHg<br />
|-<br />
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Aortic stenosis]]<br />
| style="background: #F5F5F5; padding: 5px;" |+<br />
| style="background: #F5F5F5; padding: 5px;" |+<br />
| style="background: #F5F5F5; padding: 5px;" |+<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Crescendo-decrescendo mid-systolic (or ejection systolic) murmur<br />
| style="background: #F5F5F5; padding: 5px;" |+/-<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Depending on severity<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Used for finding the location of stenosis<br />
* Finding severity<br />
* Evaluating the flow jet with color-Doppler ultrasound technique<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Non-specific at the beginning<br />
* At progressed stage calcification of the valve and cardiomegally<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
*[[Aortic calcification|Calcification score]]<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* MRI<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* MRI provides a more detailed structural and dynamic assessment of the aortic valve and left ventricle, in particular<br />
|-<br />
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Pulmonary valve stenosis|Pulmonary stenosis]]<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Depending on severity<br />
| style="background: #F5F5F5; padding: 5px;" | -<br />
| style="background: #F5F5F5; padding: 5px;" | -/+<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Continuous systolic murmur<br />
| style="background: #F5F5F5; padding: 5px;" |-<br />
| style="background: #F5F5F5; padding: 5px;" | -/+<br />
| style="background: #F5F5F5; padding: 5px;" | <br />
* Right atrial hypertrophy<br />
| style="background: #F5F5F5; padding: 5px;" | <br />
* Non-specific<br />
| style="background: #F5F5F5; padding: 5px;" | <br />
* Direct visualization of stenosis<br />
| style="background: #F5F5F5; padding: 5px;" | <br />
* Echocardiogram<br />
| style="background: #F5F5F5; padding: 5px;" | <br />
|}<br />
<br />
<br />
<br />
<br />
<br />
<br />
<br />
<br />
<br />
<br />
<br />
{| class="wikitable"<br />
|+<br />
!Diseases<br />
!Pathophysiology<br />
!Shunt<br />
!Symptoms<br />
!Diagnosis<br />
!Echocardiography findings<br />
!Physical examination<br />
!Treatment<br />
!Complications<br />
|-<br />
|Patent foramen ovale<br />
|<br />
* Failure of fusion of the septum primum and septum secundum leading to a flap valve opening.<br />
|<br />
* Right-to-left shunt<br />
<br />
* More prominent with increased right atrial pressure.<br />
|<br />
* Majority of patients are asymptomatic<br />
|<br />
* TEE (Gold standard)<br />
<br />
* TTE<br />
<br />
* TCD<br />
|<br />
* Appearance of at least 3 micro-bubbles in the left atrium within three cardiac cycles after the complete opacification of the right atrium<br />
|<br />
|<br />
* Percutaneous closure<br />
* Anticoagulants<br />
* Antiplatelets<br />
|<br />
* Paradoxical embolism<br />
<br />
* Migraine with aura<br />
*Decompression sickness in divers<br />
*Platypnea-orthodeoxia syndrome<br /><br />
|-<br />
|Atrial septal defect<br />
|<br />
* '''Ostium secundum defect''': Failure of the septum secundum to occlude the ostium secundum.<br />
<br />
* '''Ostium primum defect''': Failure of the ostium primum to fuse with the endocardial cushions.<br />
<br />
* '''Superior sinus venosus defect''': The orifice of the superior vena cava overrides the atrial septum above the fossa ovalis.<br />
<br />
* '''Inferior sinus venosus defect''': The orifice of the inferior vena cava overrides the left and right atrium.<br />
*'''Coronary sinus defect''': Absence of a portion of the common wall that separates the coronary sinus and the left atrium.<br />
|<br />
* Continuous left-to-right shunt<br />
|<br />
* Failure to thrive, tachypnea, recurrent respiratory infections, heart failure<br />
<br />
* Commonly asymptomatic during childhood and adolescence<br />
*Adults with large shunts may become symptomatic in the fourth decade presenting with fatigue, exercise intolerance, palpitations, syncope, and shortness of breath.<br />
<br />
*<br />
|<br />
* TTE (Gold standard)<br />
*Cardiac CT<br />
*Cardiac MRI<br />
|<br />
* Hypermobile interatrial septum<br />
* Abrupt septal irregularity<br />
* Right atrial and ventricular volume overload<br />
* Pulmonary artery dilation<br />
*'''Coronary sinus defect''': Enlarged ostium of the coronary sinus and unroofing of the terminal portion of the coronary sinus<br />
|<br />
* Systolic flow murmur in the pulmonary valve region<br />
*Wide, fixed splitting of S2<br />
*Diastolic flow rumble across the tricuspid valve<br />
*Right ventricular heave <br />
|<br />
* Spontaneous closure<br />
*Percutaneous transcatheter closure<br />
*Surgical closure<br />
|<br />
* Right sided heart failure<br />
* Peripheral edema<br />
* Eisenmenger syndrome (cyanosis)<br />
* Paradoxical emboli<br />
* Pulmonary hypertension<br />
|-<br />
|Pulmonary ateriovenous fistula<br />
|<br />
* Abnormal blood vessel(s) connecting the pulmonary arteries and veins directly without interposition of pulmonary capillaries<br />
|<br />
* Right-to-left shunt between the pulmonary artery and pulmonary vein<br />
|<br />
* Symptoms may occur only after the second decade<br />
*Cyanosis<br />
*Hemoptysis<br />
|<br />
* Chest CT<br />
*Pulmonary arteriogram<br />
|<br />
* Appearance of contrast bubbles in the left atrium three to five cardiac cycles after appearance in the right atrium<br />
|<br />
* Clubbing<br />
*Systolic/continuous murmur<br />
|<br />
* Embolization<br />
* Surgical resection<br />
|<br />
* Cerebral ischemia/abscess<br />
*Hemothorax<br />
|}<br />
<br />
==Differential table for aortic stenosis==<br />
<br />
{| class="wikitable"<br />
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;|Diseases<br />
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;|History<br />
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;|Symptoms<br />
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;|Physical Examination<br />
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;|Murmur<br />
! colspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;|Diagnosis<br />
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;|Other Findings<br />
|- style="background: #DCDCDC; padding: 5px; text-align: center;"<br />
!style="background: #4479BA; color: #FFFFFF; text-align: center;|ECG<br />
!style="background: #4479BA; color: #FFFFFF; text-align: center;|CXR<br />
!style="background: #4479BA; color: #FFFFFF; text-align: center;|Echocardiogram<br />
!style="background: #4479BA; color: #FFFFFF; text-align: center;|Cardiac Catheterization<br />
|-<br />
|style="background: #DCDCDC; padding: 5px; text-align: center;" |Aortic stenosis<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Age (aortic valve calcification)<br />
*Syncope<br />
*Orthopnea<br />
*Paroxysmal nocturnal dyspnea<br />
*Acute rheumatic fever<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Chest pain<br />
*Dyspnea on exertion<br />
*Palpitations<br />
*Symptoms of heart failure<br />
| style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Pulsus parvus et tardus<br />
*Pulmonary rales<br />
*Peripheral edema (In CHF patients)<br />
*Jugular venous distension<br />
*Enlarged and laterally displaced point of maximal impulse<br />
<br />
*<br />
| style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Crescendo-decrescendo systolic murmur<br />
*Best heard at the right upper sternal border<br />
*Radiation to the carotid arteries<br />
*Increases with squatting<br />
*Decreases with valsalva maneuver<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Left ventricular hypertrophy''':<br />
<br />
* Wide QRS complex (especially in leads V1-V6)<br />
*ST depression in leads V5-V6<br />
*Left axis deviation<br />
* <br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Enlarged left ventricle<br />
* Enlarged left atrium and pulmonary artery in severe cases<br />
*Calcification of the aortic valve<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Thickening and calcification of the aortic valve<br />
*Left ventricular hypertrophy<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Left heart catheterization:'''<br />
<br />
* Left ventricular and aortic pressures<br />
*The left ventricle generates higher pressures than what is transmitted to the aorta<br />
| style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Associated with von Willibrand disease<br />
|-<br />
| colspan="10" |<br />
|-<br />
|style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Mitral Stenosis]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Age ( Mitral annular calcification in older patients)<br />
<br />
* [[Rheumatic fever]]<br />
<br />
* [[Endocarditis]]<br />
<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* [[Dyspnea on exertion]]<br />
<br />
* [[Paroxysmal nocturnal dyspnea]]<br />
<br />
* [[Orthopnea]]<br />
<br />
* New onset [[atrial fibrillation]]<br />
<br />
| style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Mitral facies<br />
<br />
* Heart murmur<br />
<br />
* [[JVD|Jugular vein distension]]<br />
<br />
* Apical impulse displaced laterally or not palpable <br />
<br />
* Diastolic thrill at the apex <br />
<br />
* Signs of heart failure in severe cases<br />
| style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Diastolic murmur<br />
<br />
* Low pitched<br />
<br />
* Opening snap followed by decrescendo-crescendo rumbling murmur <br />
<br />
* Best heard with the bell of the stethoscope at apex at end-expiration in left lateral decubitus position <br />
<br />
* Intensity increases after a [[valsalva maneuver]], after exercise and after increased after load (eg., squatting, isometric hand grip) <br />
| style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* [[P mitrale]]<br />
* [[Atrial fibrillation]]: No P waves and irregularly irregular rhythm<br />
<br />
* [[Right axis deviation]]<br />
<br />
* Right ventricular hypertropy: Dominant R wave in V1 and V2<br />
| style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Straightening of the left border of the heart suggestive of enlargement of the [[left atrium]]<br />
<br />
* Double right heart border (Enlarged left atrium and normal right atrium) <br />
<br />
* Prominent left atrial appendage<br />
<br />
* Splaying of [[carina|subcarinal angle]] (>120 degrees)<br />
<br />
* Calcification of [[mitral valve]]<br />
<br />
* [[Kerley B lines]] <br />
<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Reduced valve leaflet mobility<br />
<br />
* Valve calcification <br />
<br />
* Doming of mitral valve<br />
<br />
* Valve thickening <br />
* Enlargement of left atrium <br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Right heart catheterization:'''<br />
* [[Pulmonary capillary wedge pressure]] (left atrial pressure) <br />
'''Left heart catheterization:'''<br />
* Pressures in left ventricle<br />
<br />
* Determines the gradient between the left and right atrium during ventricular diastole (marker of the severity of mitral stenosis)<br />
<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* [[Hemoptysis]] ([[heart failure]])<br />
<br />
* [[Ortner's syndrome]]<br />
|-<br />
| colspan="10" |<br />
|-<br />
|style="vertical-align: top;background: #DCDCDC; padding: 5px; text-align: center;" |[[Mitral Regurgitation]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* [[CAD]]<br />
<br />
* [[MI]]<br />
<br />
* [[Rheumatic fever]]<br />
<br />
* [[Endocarditis]]<br />
<br />
* [[Mitral valve prolapse]]<br />
<br />
* [[Cardiomyopathy]]<br />
<br />
* [[Radiation therapy]]<br />
<br />
* Trauma<br />
<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* [[Palpitations]]<br />
<br />
* Symptoms of heart failure in severe cases<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Palpation'''<br />
* Brisk carotid upstroke and hyperdymanic carotid impulse on palpation<br />
<br />
* Apical impulse is displaced to left<br />
<br />
* S3 and a palpable thrill<br />
'''Auscultation'''<br />
* Murmur<br />
<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* [[Holosystolic murmur]]<br />
<br />
* High pitched, blowing<br />
<br />
* Radiates to axilla<br />
<br />
* Best heard with the diaphragm of the stethoscope at apex in left lateral [[decubitus]] position<br />
<br />
* Intensity increases with hand grip or squatting <br />
<br />
* Decrease in intensity on standing or [[valsalva maneuver]] <br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* [[P mitrale]] in lead II<br />
* Increased QRS voltage<br />
* [[Right axis deviation]]<br />
* [[Atrial fibrillation]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Acute MR'''<br />
* [[Kerley B lines]]<br />
* No enlargement of cardiac silhouette<br />
'''Chronic MR'''<br />
* Enlarged cardiac silhouette<br />
* Straightening of left heart border<br />
* Splaying of subcarinal angle<br />
* Calcification of mitral annulus<br />
* Double right heart border<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Enlargement of left atrium and ventricle<br />
* Identify valve abnormality<br />
* Valve calcification<br />
* Severity of regurgitation<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Grading of MR is done with left ventriculography<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Decompensated and acute MR may lead to [[heart failure]]<br />
|-<br />
| colspan="10" |<br />
|-<br />
|style="vertical-align: top;background: #DCDCDC; padding: 5px; text-align: center;" |[[Atrial septal defect]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Frequent respiratory or lung infections<br />
* [[Dyspnea]]<br />
* Tiring when feeding (Infants)<br />
* Shortness of breath on exertion<br />
* [[Palpitations]]<br />
* Swelling of feet<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* [[Shortness of breath]]<br />
* [[Fatigue]]<br />
* [[Failure to thrive]]<br />
* Swelling of feet and abdomen ([[Right heart failure]])<br />
* [[Palpitations]]<br />
* Respiratory infections<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Inspection'''<br />
* Precordial bulge<br />
* Precordial lift<br />
'''Palpation'''<br />
* Right ventricular impulse<br />
* Pulmonary artery pulsations<br />
* Thrill<br />
'''Auscultation'''<br />
* Murmur<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Midsystolic (ejection systolic) murmur<br />
<br />
* Widely split, fixed S2<br />
<br />
* Upper left sternal border<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Normal <br />
* Prolonged PR interval<br />
* [[Right bundle branch block]]<br />
* ECG findings varies according to the underlying type of ASD<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
*Increased pulmonary markings<br />
*[[Cardiomegaly]]<br />
*Triangular appearance of heart<br />
*Schimitar sign<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Gold standard test for diagnosis of atrial septal defect (for more information click [[Atrial septal defect echocardiography]])<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Defect size<br />
* Pulmonary venous return<br />
* [[Pulmonary vascular resistance]]<br />
* [[Pulmonary artery hypertension]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Asymptomatic until later part of their life<br />
* May be associated with [[migraine with aura]]<br />
|-<br />
| colspan="10" |<br />
|-<br />
|style="vertical-align: top;background: #DCDCDC; padding: 5px; text-align: center;" |[[Atrial myxoma|Left Atrial Myxoma]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* [[Dyspnea]]<br />
* [[Orthopnea]]<br />
* [[Pulmonary edema]]<br />
* Hyperpigmentation of skin and endocrine activity<br />
* Cerebral [[embolism]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Symptoms may mimic mitral stenosis<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Skin'''<br />
* Signs of an embolic phenomenon<br />
* [[Raynaud's phenomenon]]<br />
* Swelling<br />
* Clubbing<br />
'''Auscultation:'''<br />
* Lung: Fine crepitations <br />
<br />
* Heart: Characteristic "tumor plop" <br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Early diastolic sound as "tumor plop"<br />
<br />
* Low frequency diastolic murmur may be heard if the tumor obstructing mitral valve <br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Often normal<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Often normal<br />
'''Rare findings:'''<br />
* [[cardiomegaly]]<br />
* Left atrial enlargement<br />
* tumor calcification etc.,<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Initial and most useful diagnostic study<br />
* For more information click [[Myxoma echocardiography or ultrasound]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Useful to detect vascular supply of the tumor by the coronary arteries <br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Associated with Carney complex (genetic predisposition)<br />
|-<br />
| colspan="10" |<br />
|-<br />
|style="vertical-align: top;background: #DCDCDC; padding: 5px; text-align: center;" |Prosthetic Valve Obstruction<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* History of valve replacement<br />
* Systemic embolism<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Shortness of breath<br />
* Fatigue<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Ausculation'''<br />
<br />
Muffling of murmur<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Muffling or disappearance of prosthetic sounds<br />
<br />
* Appearance of new regurgitant or obstructive murmur <br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Degree of stenosis<br />
* Assess thrombus size and location<br />
* Differentiate between thrombus, [[pannus]] and vegetations<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |Causes:<br />
* Thrombus<br />
* Pannus formation<br />
|-<br />
| colspan="10" |<br />
|-<br />
|style="vertical-align: top;background: #DCDCDC; padding: 5px; text-align: center;" |[[Cor Triatriatum]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Dyspnea on exertion <br />
* Recent onset of [[congestive heart failure]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Dsypnea on exertion<br />
* Orthopnea<br />
* Tachypnea<br />
* Palpitations<br />
* Growth failure<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Auscultation'''<br />
* Murmur<br />
'''Other findings'''<br />
* Signs of heart failure<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Diastolic murmur with loud P2<br />
<br />
* No opening snap or a loud S1<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |Non specific but may have<br />
* [[Right axis deviation]]<br />
* Right atrial enlargement<br />
* [[Right ventricular hypertrophy]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Normal cardiac silhouette<br />
* Hemodynamic changes similar to mitral stenosis (non specific findings)<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Direct visualization of membrane through the atrium<br />
* +/- visualization of accessory chamber<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Normal left ventricular hemodynamic profile with a trans atrial gradient<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |Types<br />
* Cor triatriatum sinistrum<br />
* Cor triatriatum dextrum<br />
|-<br />
| colspan="10" |<br />
|-<br />
|style="vertical-align: top;background: #DCDCDC; padding: 5px; text-align: center;" |Congenital Mitral Stenosis<br />
| style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Respiratory distress shortly after birth<br />
* Recurrent severe pulmonary infections<br />
* Other associated congenital cardiovascular anamolies<br />
* [[Atrial fibrillation]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
<br />
'''Infants:'''<br />
* Exhaustion and sweating on feeding<br />
* Rapid breathing<br />
* [[Failure to thrive]]<br />
* Pulmonary infections <br />
* Chronic cough<br />
'''Older patients:'''<br />
* Dyspnea<br />
* Orthopnea<br />
* Paroxysmal nocturnal dyspnea<br />
* Peripheral edema<br />
* Fatigue<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Auscultation'''<br />
* Murmur<br />
'''Other findings'''<br />
* Signs of heart failure<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Mild-Moderate'''<br />
* Loud S1<br />
<br />
* Loud P2<br />
<br />
* Low frequency diastolic murmur best heard at the apex <br />
'''Severe'''<br />
* Soft S1<br />
<br />
* Loud pulmonic component of S2 with minimal respiratory splitting of S2 <br />
<br />
* Holodiastolic murmur with presystolic accentuation best heard at the apex <br />
<br />
* Early diastolic murmur of pulmonic valve regurgitation <br />
<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
*Sharp P waves in leads I and II<br />
*Inversion of P wave in lead III<br />
*Marked Q waves in leads II and III<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Left atrial dilation<br />
* Moderate enlargement of right heart<br />
* Pulmonary venous congestion<br />
* Esophageal compression<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Reduced valve leaflet mobility<br />
* Left atrial size<br />
* Severity of mitral stenosis<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |Very rare condition<br />
|-<br />
| colspan="10" |<br />
|-<br />
|style="vertical-align: top;background: #DCDCDC; padding: 5px; text-align: center;" |Supravalvular Ring Mitral Stenosis<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Other associated congenital heart defects<br />
* Fatigue<br />
* Frequent respiratory infections<br />
* Failure to thrive<br />
* Poor feeding<br />
* Precocious congestive heart failure <br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Shortness of breath<br />
<br />
* Tachypnea<br />
* Dyspnea<br />
* Nocturnal cough<br />
* Heamoptysis<br />
* [[Syncope]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Auscultation:'''<br />
<br />
Lungs: Fine, crepitant rales and rhonchi or wheezes may be present<br />
<br />
Heart: Murmur<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* An apical mid diastolic murmur with presystolic accentuation<br />
<br />
* No opening snap<br />
<br />
* The murmur is more prominent if associated with [[VSD]] or [[PDA]]<br />
<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Left atrial and ventricular enlargement<br />
* Alveolar edema <br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Supramitral ring''':<br />
* Associated with normal mitral valve apparatus<br />
'''Intramitral ring:'''<br />
* Hypomobility of the posterior leaflet<br />
* Reduced interpapillary muscle distance<br />
* Reduced chordal length<br />
* Dominant papillary muscle<br />
* Hypoplastic mitral annulus<br />
(Difficult to visualize membrane <1mm in size)<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Persistently elevated pulmonary venous pressures<br />
* Increased pulmonary artery pressure<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Types'''<br />
* Supramitral<br />
* Intramitral<br />
It is attached between the opening of the atrial appendage and the mitral annulus which helps in differentiating with Cor triatriatum sinister.<br />
* Intramitral type is associated with shone complex<br />
|}</div>
Ifeoma odukwe
https://www.wikidoc.org/index.php?title=Sandbox:_Ifeoma&diff=1608384
Sandbox: Ifeoma
2020-05-15T23:57:39Z
<p>Ifeoma odukwe: </p>
<hr />
<div>: A colon indents a line or paragraph<br />
'''A colon indents a line or paragraph'''<br />
<br />
<br />
<br />
<br />
<br />
==Classification of dextrocardia==<br />
{| style="border: 0px; font-size: 90%; margin: 3px; width: 1000px"<br />
|valign=top|<br />
|+<br />
! style="background: #4479BA; width: 250px; color: #FFFFFF;"|'''Dextrocardia Types'''<br />
<br />
! style="background: #4479BA; width: 600px; color: #FFFFFF;"|'''Description'''<br />
<br />
|-<br />
<br />
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align=center | '''Dextrocardia with situs solitus '''|| style="padding: 5px 5px; background: #F5F5F5;" |<br />
:* Dextrocardia with normally related great arteries and D-transposition (complete transposition) or L-transposition (congenitally corrected transposition) of the great arteries. Some examples include dextrocardia with D-loop ventricles and normally related great arteries, with L-loop ventricles and L-TGA (congenitally corrected TGA).<br />
:* Embryologic failure of the final leftward shift of the ventricles during development results in dextrocardia with situs solitus, D-loop ventricles, and normally related great arteries.<br />
<br />
|-<br />
<br />
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align=center | '''Dextrocardia with situs inversus '''|| style="padding: 5px 5px; background: #F5F5F5;"|<br />
:* May present with dextrocardia with inversely related great arteries and D-transposition (congenitally corrected transposition) or L-transposition (“uncorrected” transposition) of the great arteries. An example is dextrocardia with D-loop ventricles and D-TGA (congenitally corrected TGA).<br />
<br />
|-<br />
<br />
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align=center | '''Dextrocardia with situs ambiguous (either polyspenia or asplenia)''' || style="padding: 5px 5px; background: #F5F5F5;"|<br />
:* Dextrocardia with any of the above relationships between the ventricles and great vessels.<br />
<br />
|-<br />
<br />
<br />
{|<br />
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"<br />
! rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;|Diseases<br />
| colspan="6" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;|'''Clinical manifestations'''<br />
! colspan="3" rowspan="2" |Para-clinical findings<br />
| colspan="1" rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;|'''Gold standard'''<br />
! rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;|Additional findings<br />
|-<br />
| colspan="3" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;|'''Symptoms'''<br />
! colspan="3" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;|Physical examination<br />
|-<br />
! colspan="3" style="background: #4479BA; color: #FFFFFF; text-align: center;|Imaging<br />
|- <br />
! style="background: #4479BA; color: #FFFFFF; text-align: center;|Exertional dyspnea<br />
! colspan="1" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;|Failure to thrive<br />
! style="background: #4479BA; color: #FFFFFF; text-align: center;|Recurrent respiratory infections<br />
! style="background: #4479BA; color: #FFFFFF; text-align: center;|Murmur on auscultation<br />
! colspan="1" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;|Peripheral edema<br />
! style="background: #4479BA; color: #FFFFFF; text-align: center;|Clubbing<br />
! style="background: #4479BA; color: #FFFFFF; text-align: center;|Echocardiography<br />
! style="background: #4479BA; color: #FFFFFF; text-align: center;|Chest x-ray<br />
! style="background: #4479BA; color: #FFFFFF; text-align: center;|Cardiac CT<br />
|-<br />
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Patent foramen ovale]]<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Appearance of at least 3 micro-bubbles in the left atrium within three cardiac cycles after complete opacification of the right atrium<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | Non specific<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | <br />
* A contrast agent jet from the left atrium to the right atrium toward the inferior vena cava with channel-like appearance of the interatrial septum<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Echocardiogram<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* It is associated with paradoxical embolism, migraine headache, and decompression sickness in divers<br />
|-<br />
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Atrial septal defect]]<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/−<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/−<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/− <br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Systolic flow murmur in the upper left sternal border<br />
* Wide, fixed splitting of S2<br />
* Diastolic flow rumble across the tricuspid valve<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/−<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/−<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Hypermobile interatrial septum<br />
* Abrupt septal irregularity<br />
* Right atrial and ventricular volume overload<br />
* Pulmonary artery dilatation<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Cardiomegaly <br />
* Pulmonary artery enlargement/increased pulmonary vascularity<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Enlargement of the right atrium and ventricle<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Echocardiogram<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Atrial septal defect is classified into 5 types including ostium primum defect, ostium secundum defect, superior sinus venosus defect, inferior sinus venosus defect, and coronary sinus defect<br />
|-<br />
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Ventricular septal defect]]<br />
| style="background: #F5F5F5; padding: 5px;" |-/+<br />
| style="background: #F5F5F5; padding: 5px;" |-/+<br />
| style="background: #F5F5F5; padding: 5px;" |After Eisenmenger syndrome<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Holosystolic murmur<br />
* May mimic aortic stenosis(mid/end dyastolic murmur due to increased pulmonary circulation)<br />
| style="background: #F5F5F5; padding: 5px;" |-/+<br />
| style="background: #F5F5F5; padding: 5px;" |-/+<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Defect localization<br />
*septal dropout in the area adjacent to the tricuspid septal leaflet and below the right border of the aortic annulus<br />
* Direction of jet<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* [[Cardiomegaly]] in large VSD<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Direct visualisation of murmur<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Echocardiogram<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"<br />
!Diseases<br />
!Exertional dyspnea<br />
! colspan="1" rowspan="1" |Failure to thrive<br />
!Recurrent respiratory infections<br />
!Murmur on auscultation<br />
! colspan="1" rowspan="1" |Peripheral edema<br />
!Clubbing<br />
!Echocardiography<br />
!Chest x-ray<br />
!Cardiac CT<br />
|'''Gold standard'''<br />
!Additional findings<br />
|-<br />
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Patent ductus arteriosus]]<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Not at beginning<br />
* May be produced during the course of disease <br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Depends on the size<br />
| style="background: #F5F5F5; padding: 5px;" | -<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Continuous machine-like murmur<br />
| style="background: #F5F5F5; padding: 5px;" |-<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* May be present by progressing<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Golden standard <br />
* In color-Doppler visualization of flow through the patent duct which has a high velocity<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Non-specific<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Used for determining Krichenko classification<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Echocardiogram<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Krichenko criteria for classification is a very important factor for treatment<br />
|-<br />
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Aortic coarctation|Coarctation of the aorta]]<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/−<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/−<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Systolic murmur over the upper sternal border with radiation to the back<br />
*Murmur of mitral regurgitation (holosystolic murmur best heard at the apex)<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Narrowing of the aortic arch at the level of the isthmus<br />
* Left ventricular hypertrophy<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Notching of the posterior fourth to eighth ribs due to dilated intercostal arteries<br />
* Indentation of the aorta at the site of coarctation with pre- and post-stenotic dilation of the aorta (classic "3 sign")<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Dilation of the intercostal arteries<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Echocardiogram<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
*Patients present with arm-leg blood pressure gradient of >20mmHg<br />
|-<br />
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Aortic stenosis]]<br />
| style="background: #F5F5F5; padding: 5px;" |+<br />
| style="background: #F5F5F5; padding: 5px;" |+<br />
| style="background: #F5F5F5; padding: 5px;" |+<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Crescendo-decrescendo mid-systolic (or ejection systolic) murmur<br />
| style="background: #F5F5F5; padding: 5px;" |+/-<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Depending on severity<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Used for finding the location of stenosis<br />
* Finding severity<br />
* Evaluating the flow jet with color-Doppler ultrasound technique<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Non-specific at the beginning<br />
* At progressed stage calcification of the valve and cardiomegally<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
*[[Aortic calcification|Calcification score]]<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* MRI<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* MRI provides a more detailed structural and dynamic assessment of the aortic valve and left ventricle, in particular<br />
|-<br />
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Pulmonary valve stenosis|Pulmonary stenosis]]<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Depending on severity<br />
| style="background: #F5F5F5; padding: 5px;" | -<br />
| style="background: #F5F5F5; padding: 5px;" | -/+<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Continuous systolic murmur<br />
| style="background: #F5F5F5; padding: 5px;" |-<br />
| style="background: #F5F5F5; padding: 5px;" | -/+<br />
| style="background: #F5F5F5; padding: 5px;" | <br />
* Right atrial hypertrophy<br />
| style="background: #F5F5F5; padding: 5px;" | <br />
* Non-specific<br />
| style="background: #F5F5F5; padding: 5px;" | <br />
* Direct visualization of stenosis<br />
| style="background: #F5F5F5; padding: 5px;" | <br />
* Echocardiogram<br />
| style="background: #F5F5F5; padding: 5px;" | <br />
|}<br />
<br />
<br />
<br />
<br />
<br />
<br />
<br />
<br />
<br />
<br />
<br />
{| class="wikitable"<br />
|+<br />
!Diseases<br />
!Pathophysiology<br />
!Shunt<br />
!Symptoms<br />
!Diagnosis<br />
!Echocardiography findings<br />
!Physical examination<br />
!Treatment<br />
!Complications<br />
|-<br />
|Patent foramen ovale<br />
|<br />
* Failure of fusion of the septum primum and septum secundum leading to a flap valve opening.<br />
|<br />
* Right-to-left shunt<br />
<br />
* More prominent with increased right atrial pressure.<br />
|<br />
* Majority of patients are asymptomatic<br />
|<br />
* TEE (Gold standard)<br />
<br />
* TTE<br />
<br />
* TCD<br />
|<br />
* Appearance of at least 3 micro-bubbles in the left atrium within three cardiac cycles after the complete opacification of the right atrium<br />
|<br />
|<br />
* Percutaneous closure<br />
* Anticoagulants<br />
* Antiplatelets<br />
|<br />
* Paradoxical embolism<br />
<br />
* Migraine with aura<br />
*Decompression sickness in divers<br />
*Platypnea-orthodeoxia syndrome<br /><br />
|-<br />
|Atrial septal defect<br />
|<br />
* '''Ostium secundum defect''': Failure of the septum secundum to occlude the ostium secundum.<br />
<br />
* '''Ostium primum defect''': Failure of the ostium primum to fuse with the endocardial cushions.<br />
<br />
* '''Superior sinus venosus defect''': The orifice of the superior vena cava overrides the atrial septum above the fossa ovalis.<br />
<br />
* '''Inferior sinus venosus defect''': The orifice of the inferior vena cava overrides the left and right atrium.<br />
*'''Coronary sinus defect''': Absence of a portion of the common wall that separates the coronary sinus and the left atrium.<br />
|<br />
* Continuous left-to-right shunt<br />
|<br />
* Failure to thrive, tachypnea, recurrent respiratory infections, heart failure<br />
<br />
* Commonly asymptomatic during childhood and adolescence<br />
*Adults with large shunts may become symptomatic in the fourth decade presenting with fatigue, exercise intolerance, palpitations, syncope, and shortness of breath.<br />
<br />
*<br />
|<br />
* TTE (Gold standard)<br />
*Cardiac CT<br />
*Cardiac MRI<br />
|<br />
* Hypermobile interatrial septum<br />
* Abrupt septal irregularity<br />
* Right atrial and ventricular volume overload<br />
* Pulmonary artery dilation<br />
*'''Coronary sinus defect''': Enlarged ostium of the coronary sinus and unroofing of the terminal portion of the coronary sinus<br />
|<br />
* Systolic flow murmur in the pulmonary valve region<br />
*Wide, fixed splitting of S2<br />
*Diastolic flow rumble across the tricuspid valve<br />
*Right ventricular heave <br />
|<br />
* Spontaneous closure<br />
*Percutaneous transcatheter closure<br />
*Surgical closure<br />
|<br />
* Right sided heart failure<br />
* Peripheral edema<br />
* Eisenmenger syndrome (cyanosis)<br />
* Paradoxical emboli<br />
* Pulmonary hypertension<br />
|-<br />
|Pulmonary ateriovenous fistula<br />
|<br />
* Abnormal blood vessel(s) connecting the pulmonary arteries and veins directly without interposition of pulmonary capillaries<br />
|<br />
* Right-to-left shunt between the pulmonary artery and pulmonary vein<br />
|<br />
* Symptoms may occur only after the second decade<br />
*Cyanosis<br />
*Hemoptysis<br />
|<br />
* Chest CT<br />
*Pulmonary arteriogram<br />
|<br />
* Appearance of contrast bubbles in the left atrium three to five cardiac cycles after appearance in the right atrium<br />
|<br />
* Clubbing<br />
*Systolic/continuous murmur<br />
|<br />
* Embolization<br />
* Surgical resection<br />
|<br />
* Cerebral ischemia/abscess<br />
*Hemothorax<br />
|}<br />
<br />
==Differential table for aortic stenosis==<br />
<br />
{| class="wikitable"<br />
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;|Diseases<br />
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;|History<br />
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;|Symptoms<br />
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;|Physical Examination<br />
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;|Murmur<br />
! colspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;|Diagnosis<br />
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;|Other Findings<br />
|- style="background: #DCDCDC; padding: 5px; text-align: center;"<br />
!style="background: #4479BA; color: #FFFFFF; text-align: center;|ECG<br />
!style="background: #4479BA; color: #FFFFFF; text-align: center;|CXR<br />
!style="background: #4479BA; color: #FFFFFF; text-align: center;|Echocardiogram<br />
!style="background: #4479BA; color: #FFFFFF; text-align: center;|Cardiac Catheterization<br />
|-<br />
|style="background: #DCDCDC; padding: 5px; text-align: center;" |Aortic stenosis<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Age (aortic valve calcification)<br />
*Syncope<br />
*Orthopnea<br />
*Paroxysmal nocturnal dyspnea<br />
*Acute rheumatic fever<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Chest pain<br />
*Dyspnea on exertion<br />
*Palpitations<br />
*Symptoms of heart failure<br />
| style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Pulsus parvus et tardus<br />
*Pulmonary rales<br />
*Peripheral edema (In CHF patients)<br />
*Jugular venous distension<br />
*Enlarged and laterally displaced point of maximal impulse<br />
<br />
*<br />
| style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Crescendo-decrescendo systolic murmur<br />
*Best heard at the right upper sternal border<br />
*Radiation to the carotid arteries<br />
*Increases with squatting<br />
*Decreases with valsalva maneuver<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Left ventricular hypertrophy''':<br />
<br />
* Wide QRS complex (especially in leads V1-V6)<br />
*ST depression in leads V5-V6<br />
*Left axis deviation<br />
* <br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Enlarged left ventricle<br />
* Enlarged left atrium and pulmonary artery in severe cases<br />
*Calcification of the aortic valve<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Thickening and calcification of the aortic valve<br />
*Left ventricular hypertrophy<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Left heart catheterization:'''<br />
<br />
* Left ventricular and aortic pressures<br />
*The left ventricle generates higher pressures than what is transmitted to the aorta<br />
| style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Associated with von Willibrand disease<br />
|-<br />
| colspan="10" |<br />
|-<br />
|style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Mitral Stenosis]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Age ( Mitral annular calcification in older patients)<br />
<br />
* [[Rheumatic fever]]<br />
<br />
* [[Endocarditis]]<br />
<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* [[Dyspnea on exertion]]<br />
<br />
* [[Paroxysmal nocturnal dyspnea]]<br />
<br />
* [[Orthopnea]]<br />
<br />
* New onset [[atrial fibrillation]]<br />
<br />
| style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Mitral facies<br />
<br />
* Heart murmur<br />
<br />
* [[JVD|Jugular vein distension]]<br />
<br />
* Apical impulse displaced laterally or not palpable <br />
<br />
* Diastolic thrill at the apex <br />
<br />
* Signs of heart failure in severe cases<br />
| style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Diastolic murmur<br />
<br />
* Low pitched<br />
<br />
* Opening snap followed by decrescendo-crescendo rumbling murmur <br />
<br />
* Best heard with the bell of the stethoscope at apex at end-expiration in left lateral decubitus position <br />
<br />
* Intensity increases after a [[valsalva maneuver]], after exercise and after increased after load (eg., squatting, isometric hand grip) <br />
| style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* [[P mitrale]]<br />
* [[Atrial fibrillation]]: No P waves and irregularly irregular rhythm<br />
<br />
* [[Right axis deviation]]<br />
<br />
* Right ventricular hypertropy: Dominant R wave in V1 and V2<br />
| style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Straightening of the left border of the heart suggestive of enlargement of the [[left atrium]]<br />
<br />
* Double right heart border (Enlarged left atrium and normal right atrium) <br />
<br />
* Prominent left atrial appendage<br />
<br />
* Splaying of [[carina|subcarinal angle]] (>120 degrees)<br />
<br />
* Calcification of [[mitral valve]]<br />
<br />
* [[Kerley B lines]] <br />
<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Reduced valve leaflet mobility<br />
<br />
* Valve calcification <br />
<br />
* Doming of mitral valve<br />
<br />
* Valve thickening <br />
* Enlargement of left atrium <br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Right heart catheterization:'''<br />
* [[Pulmonary capillary wedge pressure]] (left atrial pressure) <br />
'''Left heart catheterization:'''<br />
* Pressures in left ventricle<br />
<br />
* Determines the gradient between the left and right atrium during ventricular diastole (marker of the severity of mitral stenosis)<br />
<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* [[Hemoptysis]] ([[heart failure]])<br />
<br />
* [[Ortner's syndrome]]<br />
|-<br />
| colspan="10" |<br />
|-<br />
|style="vertical-align: top;background: #DCDCDC; padding: 5px; text-align: center;" |[[Mitral Regurgitation]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* [[CAD]]<br />
<br />
* [[MI]]<br />
<br />
* [[Rheumatic fever]]<br />
<br />
* [[Endocarditis]]<br />
<br />
* [[Mitral valve prolapse]]<br />
<br />
* [[Cardiomyopathy]]<br />
<br />
* [[Radiation therapy]]<br />
<br />
* Trauma<br />
<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* [[Palpitations]]<br />
<br />
* Symptoms of heart failure in severe cases<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Palpation'''<br />
* Brisk carotid upstroke and hyperdymanic carotid impulse on palpation<br />
<br />
* Apical impulse is displaced to left<br />
<br />
* S3 and a palpable thrill<br />
'''Auscultation'''<br />
* Murmur<br />
<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* [[Holosystolic murmur]]<br />
<br />
* High pitched, blowing<br />
<br />
* Radiates to axilla<br />
<br />
* Best heard with the diaphragm of the stethoscope at apex in left lateral [[decubitus]] position<br />
<br />
* Intensity increases with hand grip or squatting <br />
<br />
* Decrease in intensity on standing or [[valsalva maneuver]] <br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* [[P mitrale]] in lead II<br />
* Increased QRS voltage<br />
* [[Right axis deviation]]<br />
* [[Atrial fibrillation]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Acute MR'''<br />
* [[Kerley B lines]]<br />
* No enlargement of cardiac silhouette<br />
'''Chronic MR'''<br />
* Enlarged cardiac silhouette<br />
* Straightening of left heart border<br />
* Splaying of subcarinal angle<br />
* Calcification of mitral annulus<br />
* Double right heart border<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Enlargement of left atrium and ventricle<br />
* Identify valve abnormality<br />
* Valve calcification<br />
* Severity of regurgitation<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Grading of MR is done with left ventriculography<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Decompensated and acute MR may lead to [[heart failure]]<br />
|-<br />
| colspan="10" |<br />
|-<br />
|style="vertical-align: top;background: #DCDCDC; padding: 5px; text-align: center;" |[[Atrial septal defect]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Frequent respiratory or lung infections<br />
* [[Dyspnea]]<br />
* Tiring when feeding (Infants)<br />
* Shortness of breath on exertion<br />
* [[Palpitations]]<br />
* Swelling of feet<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* [[Shortness of breath]]<br />
* [[Fatigue]]<br />
* [[Failure to thrive]]<br />
* Swelling of feet and abdomen ([[Right heart failure]])<br />
* [[Palpitations]]<br />
* Respiratory infections<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Inspection'''<br />
* Precordial bulge<br />
* Precordial lift<br />
'''Palpation'''<br />
* Right ventricular impulse<br />
* Pulmonary artery pulsations<br />
* Thrill<br />
'''Auscultation'''<br />
* Murmur<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Midsystolic (ejection systolic) murmur<br />
<br />
* Widely split, fixed S2<br />
<br />
* Upper left sternal border<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Normal <br />
* Prolonged PR interval<br />
* [[Right bundle branch block]]<br />
* ECG findings varies according to the underlying type of ASD<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
*Increased pulmonary markings<br />
*[[Cardiomegaly]]<br />
*Triangular appearance of heart<br />
*Schimitar sign<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Gold standard test for diagnosis of atrial septal defect (for more information click [[Atrial septal defect echocardiography]])<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Defect size<br />
* Pulmonary venous return<br />
* [[Pulmonary vascular resistance]]<br />
* [[Pulmonary artery hypertension]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Asymptomatic until later part of their life<br />
* May be associated with [[migraine with aura]]<br />
|-<br />
| colspan="10" |<br />
|-<br />
|style="vertical-align: top;background: #DCDCDC; padding: 5px; text-align: center;" |[[Atrial myxoma|Left Atrial Myxoma]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* [[Dyspnea]]<br />
* [[Orthopnea]]<br />
* [[Pulmonary edema]]<br />
* Hyperpigmentation of skin and endocrine activity<br />
* Cerebral [[embolism]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Symptoms may mimic mitral stenosis<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Skin'''<br />
* Signs of an embolic phenomenon<br />
* [[Raynaud's phenomenon]]<br />
* Swelling<br />
* Clubbing<br />
'''Auscultation:'''<br />
* Lung: Fine crepitations <br />
<br />
* Heart: Characteristic "tumor plop" <br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Early diastolic sound as "tumor plop"<br />
<br />
* Low frequency diastolic murmur may be heard if the tumor obstructing mitral valve <br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Often normal<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Often normal<br />
'''Rare findings:'''<br />
* [[cardiomegaly]]<br />
* Left atrial enlargement<br />
* tumor calcification etc.,<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Initial and most useful diagnostic study<br />
* For more information click [[Myxoma echocardiography or ultrasound]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Useful to detect vascular supply of the tumor by the coronary arteries <br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Associated with Carney complex (genetic predisposition)<br />
|-<br />
| colspan="10" |<br />
|-<br />
|style="vertical-align: top;background: #DCDCDC; padding: 5px; text-align: center;" |Prosthetic Valve Obstruction<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* History of valve replacement<br />
* Systemic embolism<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Shortness of breath<br />
* Fatigue<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Ausculation'''<br />
<br />
Muffling of murmur<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Muffling or disappearance of prosthetic sounds<br />
<br />
* Appearance of new regurgitant or obstructive murmur <br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Degree of stenosis<br />
* Assess thrombus size and location<br />
* Differentiate between thrombus, [[pannus]] and vegetations<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |Causes:<br />
* Thrombus<br />
* Pannus formation<br />
|-<br />
| colspan="10" |<br />
|-<br />
|style="vertical-align: top;background: #DCDCDC; padding: 5px; text-align: center;" |[[Cor Triatriatum]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Dyspnea on exertion <br />
* Recent onset of [[congestive heart failure]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Dsypnea on exertion<br />
* Orthopnea<br />
* Tachypnea<br />
* Palpitations<br />
* Growth failure<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Auscultation'''<br />
* Murmur<br />
'''Other findings'''<br />
* Signs of heart failure<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Diastolic murmur with loud P2<br />
<br />
* No opening snap or a loud S1<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |Non specific but may have<br />
* [[Right axis deviation]]<br />
* Right atrial enlargement<br />
* [[Right ventricular hypertrophy]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Normal cardiac silhouette<br />
* Hemodynamic changes similar to mitral stenosis (non specific findings)<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Direct visualization of membrane through the atrium<br />
* +/- visualization of accessory chamber<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Normal left ventricular hemodynamic profile with a trans atrial gradient<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |Types<br />
* Cor triatriatum sinistrum<br />
* Cor triatriatum dextrum<br />
|-<br />
| colspan="10" |<br />
|-<br />
|style="vertical-align: top;background: #DCDCDC; padding: 5px; text-align: center;" |Congenital Mitral Stenosis<br />
| style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Respiratory distress shortly after birth<br />
* Recurrent severe pulmonary infections<br />
* Other associated congenital cardiovascular anamolies<br />
* [[Atrial fibrillation]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
<br />
'''Infants:'''<br />
* Exhaustion and sweating on feeding<br />
* Rapid breathing<br />
* [[Failure to thrive]]<br />
* Pulmonary infections <br />
* Chronic cough<br />
'''Older patients:'''<br />
* Dyspnea<br />
* Orthopnea<br />
* Paroxysmal nocturnal dyspnea<br />
* Peripheral edema<br />
* Fatigue<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Auscultation'''<br />
* Murmur<br />
'''Other findings'''<br />
* Signs of heart failure<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Mild-Moderate'''<br />
* Loud S1<br />
<br />
* Loud P2<br />
<br />
* Low frequency diastolic murmur best heard at the apex <br />
'''Severe'''<br />
* Soft S1<br />
<br />
* Loud pulmonic component of S2 with minimal respiratory splitting of S2 <br />
<br />
* Holodiastolic murmur with presystolic accentuation best heard at the apex <br />
<br />
* Early diastolic murmur of pulmonic valve regurgitation <br />
<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
*Sharp P waves in leads I and II<br />
*Inversion of P wave in lead III<br />
*Marked Q waves in leads II and III<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Left atrial dilation<br />
* Moderate enlargement of right heart<br />
* Pulmonary venous congestion<br />
* Esophageal compression<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Reduced valve leaflet mobility<br />
* Left atrial size<br />
* Severity of mitral stenosis<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |Very rare condition<br />
|-<br />
| colspan="10" |<br />
|-<br />
|style="vertical-align: top;background: #DCDCDC; padding: 5px; text-align: center;" |Supravalvular Ring Mitral Stenosis<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Other associated congenital heart defects<br />
* Fatigue<br />
* Frequent respiratory infections<br />
* Failure to thrive<br />
* Poor feeding<br />
* Precocious congestive heart failure <br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Shortness of breath<br />
<br />
* Tachypnea<br />
* Dyspnea<br />
* Nocturnal cough<br />
* Heamoptysis<br />
* [[Syncope]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Auscultation:'''<br />
<br />
Lungs: Fine, crepitant rales and rhonchi or wheezes may be present<br />
<br />
Heart: Murmur<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* An apical mid diastolic murmur with presystolic accentuation<br />
<br />
* No opening snap<br />
<br />
* The murmur is more prominent if associated with [[VSD]] or [[PDA]]<br />
<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Left atrial and ventricular enlargement<br />
* Alveolar edema <br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Supramitral ring''':<br />
* Associated with normal mitral valve apparatus<br />
'''Intramitral ring:'''<br />
* Hypomobility of the posterior leaflet<br />
* Reduced interpapillary muscle distance<br />
* Reduced chordal length<br />
* Dominant papillary muscle<br />
* Hypoplastic mitral annulus<br />
(Difficult to visualize membrane <1mm in size)<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Persistently elevated pulmonary venous pressures<br />
* Increased pulmonary artery pressure<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Types'''<br />
* Supramitral<br />
* Intramitral<br />
It is attached between the opening of the atrial appendage and the mitral annulus which helps in differentiating with Cor triatriatum sinister.<br />
* Intramitral type is associated with shone complex<br />
|}</div>
Ifeoma odukwe
https://www.wikidoc.org/index.php?title=Sandbox:_Ifeoma&diff=1608375
Sandbox: Ifeoma
2020-05-15T23:34:38Z
<p>Ifeoma odukwe: </p>
<hr />
<div>: A colon indents a line or paragraph<br />
<br />
<br />
<br />
<br />
<br />
<br />
<br />
==Classification of dextrocardia==<br />
{| style="border: 0px; font-size: 90%; margin: 3px; width: 1000px"<br />
|valign=top|<br />
|+<br />
! style="background: #4479BA; width: 250px; color: #FFFFFF;"|'''Dextrocardia Types'''<br />
<br />
! style="background: #4479BA; width: 600px; color: #FFFFFF;"|'''Description'''<br />
<br />
|-<br />
<br />
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align=center | '''Dextrocardia with situs solitus '''|| style="padding: 5px 5px; background: #F5F5F5;" |<br />
:* Dextrocardia with normally related great arteries and D-transposition (complete transposition) or L-transposition (congenitally corrected transposition) of the great arteries. Some examples include dextrocardia with D-loop ventricles and normally related great arteries, with L-loop ventricles and L-TGA (congenitally corrected TGA).<br />
:* Embryologic failure of the final leftward shift of the ventricles during development results in dextrocardia with situs solitus, D-loop ventricles, and normally related great arteries.<br />
<br />
|-<br />
<br />
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align=center | '''Dextrocardia with situs inversus '''|| style="padding: 5px 5px; background: #F5F5F5;"|<br />
:* May present with dextrocardia with inversely related great arteries and D-transposition (congenitally corrected transposition) or L-transposition (“uncorrected” transposition) of the great arteries. An example is dextrocardia with D-loop ventricles and D-TGA (congenitally corrected TGA).<br />
<br />
|-<br />
<br />
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align=center | '''Dextrocardia with situs ambiguous (either polyspenia or asplenia)''' || style="padding: 5px 5px; background: #F5F5F5;"|<br />
:* Dextrocardia with any of the above relationships between the ventricles and great vessels.<br />
<br />
|-<br />
<br />
<br />
{|<br />
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"<br />
! rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;|Diseases<br />
| colspan="6" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;|'''Clinical manifestations'''<br />
! colspan="3" rowspan="2" |Para-clinical findings<br />
| colspan="1" rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;|'''Gold standard'''<br />
! rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;|Additional findings<br />
|-<br />
| colspan="3" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;|'''Symptoms'''<br />
! colspan="3" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;|Physical examination<br />
|-<br />
! colspan="3" style="background: #4479BA; color: #FFFFFF; text-align: center;|Imaging<br />
|- <br />
! style="background: #4479BA; color: #FFFFFF; text-align: center;|Exertional dyspnea<br />
! colspan="1" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;|Failure to thrive<br />
! style="background: #4479BA; color: #FFFFFF; text-align: center;|Recurrent respiratory infections<br />
! style="background: #4479BA; color: #FFFFFF; text-align: center;|Murmur on auscultation<br />
! colspan="1" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;|Peripheral edema<br />
! style="background: #4479BA; color: #FFFFFF; text-align: center;|Clubbing<br />
! style="background: #4479BA; color: #FFFFFF; text-align: center;|Echocardiography<br />
! style="background: #4479BA; color: #FFFFFF; text-align: center;|Chest x-ray<br />
! style="background: #4479BA; color: #FFFFFF; text-align: center;|Cardiac CT<br />
|-<br />
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Patent foramen ovale]]<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Appearance of at least 3 micro-bubbles in the left atrium within three cardiac cycles after complete opacification of the right atrium<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | Non specific<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | <br />
* A contrast agent jet from the left atrium to the right atrium toward the inferior vena cava with channel-like appearance of the interatrial septum<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Echocardiogram<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* It is associated with paradoxical embolism, migraine headache, and decompression sickness in divers<br />
|-<br />
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Atrial septal defect]]<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/−<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/−<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/− <br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Systolic flow murmur in the upper left sternal border<br />
* Wide, fixed splitting of S2<br />
* Diastolic flow rumble across the tricuspid valve<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/−<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/−<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Hypermobile interatrial septum<br />
* Abrupt septal irregularity<br />
* Right atrial and ventricular volume overload<br />
* Pulmonary artery dilatation<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Cardiomegaly <br />
* Pulmonary artery enlargement/increased pulmonary vascularity<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Enlargement of the right atrium and ventricle<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Echocardiogram<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Atrial septal defect is classified into 5 types including ostium primum defect, ostium secundum defect, superior sinus venosus defect, inferior sinus venosus defect, and coronary sinus defect<br />
|-<br />
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Ventricular septal defect]]<br />
| style="background: #F5F5F5; padding: 5px;" |-/+<br />
| style="background: #F5F5F5; padding: 5px;" |-/+<br />
| style="background: #F5F5F5; padding: 5px;" |After Eisenmenger syndrome<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Holosystolic murmur<br />
* May mimic aortic stenosis(mid/end dyastolic murmur due to increased pulmonary circulation)<br />
| style="background: #F5F5F5; padding: 5px;" |-/+<br />
| style="background: #F5F5F5; padding: 5px;" |-/+<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Defect localization<br />
*septal dropout in the area adjacent to the tricuspid septal leaflet and below the right border of the aortic annulus<br />
* Direction of jet<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* [[Cardiomegaly]] in large VSD<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Direct visualisation of murmur<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Echocardiogram<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"<br />
!Diseases<br />
!Exertional dyspnea<br />
! colspan="1" rowspan="1" |Failure to thrive<br />
!Recurrent respiratory infections<br />
!Murmur on auscultation<br />
! colspan="1" rowspan="1" |Peripheral edema<br />
!Clubbing<br />
!Echocardiography<br />
!Chest x-ray<br />
!Cardiac CT<br />
|'''Gold standard'''<br />
!Additional findings<br />
|-<br />
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Patent ductus arteriosus]]<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Not at beginning<br />
* May be produced during the course of disease <br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Depends on the size<br />
| style="background: #F5F5F5; padding: 5px;" | -<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Continuous machine-like murmur<br />
| style="background: #F5F5F5; padding: 5px;" |-<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* May be present by progressing<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Golden standard <br />
* In color-Doppler visualization of flow through the patent duct which has a high velocity<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Non-specific<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Used for determining Krichenko classification<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Echocardiogram<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Krichenko criteria for classification is a very important factor for treatment<br />
|-<br />
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Aortic coarctation|Coarctation of the aorta]]<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/−<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/−<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Systolic murmur over the upper sternal border with radiation to the back<br />
*Murmur of mitral regurgitation (holosystolic murmur best heard at the apex)<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Narrowing of the aortic arch at the level of the isthmus<br />
* Left ventricular hypertrophy<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Notching of the posterior fourth to eighth ribs due to dilated intercostal arteries<br />
* Indentation of the aorta at the site of coarctation with pre- and post-stenotic dilation of the aorta (classic "3 sign")<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Dilation of the intercostal arteries<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Echocardiogram<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
*Patients present with arm-leg blood pressure gradient of >20mmHg<br />
|-<br />
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Aortic stenosis]]<br />
| style="background: #F5F5F5; padding: 5px;" |+<br />
| style="background: #F5F5F5; padding: 5px;" |+<br />
| style="background: #F5F5F5; padding: 5px;" |+<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Crescendo-decrescendo mid-systolic (or ejection systolic) murmur<br />
| style="background: #F5F5F5; padding: 5px;" |+/-<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Depending on severity<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Used for finding the location of stenosis<br />
* Finding severity<br />
* Evaluating the flow jet with color-Doppler ultrasound technique<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Non-specific at the beginning<br />
* At progressed stage calcification of the valve and cardiomegally<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
*[[Aortic calcification|Calcification score]]<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* MRI<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* MRI provides a more detailed structural and dynamic assessment of the aortic valve and left ventricle, in particular<br />
|-<br />
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Pulmonary valve stenosis|Pulmonary stenosis]]<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Depending on severity<br />
| style="background: #F5F5F5; padding: 5px;" | -<br />
| style="background: #F5F5F5; padding: 5px;" | -/+<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
* Continuous systolic murmur<br />
| style="background: #F5F5F5; padding: 5px;" |-<br />
| style="background: #F5F5F5; padding: 5px;" | -/+<br />
| style="background: #F5F5F5; padding: 5px;" | <br />
* Right atrial hypertrophy<br />
| style="background: #F5F5F5; padding: 5px;" | <br />
* Non-specific<br />
| style="background: #F5F5F5; padding: 5px;" | <br />
* Direct visualization of stenosis<br />
| style="background: #F5F5F5; padding: 5px;" | <br />
* Echocardiogram<br />
| style="background: #F5F5F5; padding: 5px;" | <br />
|}<br />
<br />
<br />
<br />
<br />
<br />
<br />
<br />
<br />
<br />
<br />
<br />
{| class="wikitable"<br />
|+<br />
!Diseases<br />
!Pathophysiology<br />
!Shunt<br />
!Symptoms<br />
!Diagnosis<br />
!Echocardiography findings<br />
!Physical examination<br />
!Treatment<br />
!Complications<br />
|-<br />
|Patent foramen ovale<br />
|<br />
* Failure of fusion of the septum primum and septum secundum leading to a flap valve opening.<br />
|<br />
* Right-to-left shunt<br />
<br />
* More prominent with increased right atrial pressure.<br />
|<br />
* Majority of patients are asymptomatic<br />
|<br />
* TEE (Gold standard)<br />
<br />
* TTE<br />
<br />
* TCD<br />
|<br />
* Appearance of at least 3 micro-bubbles in the left atrium within three cardiac cycles after the complete opacification of the right atrium<br />
|<br />
|<br />
* Percutaneous closure<br />
* Anticoagulants<br />
* Antiplatelets<br />
|<br />
* Paradoxical embolism<br />
<br />
* Migraine with aura<br />
*Decompression sickness in divers<br />
*Platypnea-orthodeoxia syndrome<br /><br />
|-<br />
|Atrial septal defect<br />
|<br />
* '''Ostium secundum defect''': Failure of the septum secundum to occlude the ostium secundum.<br />
<br />
* '''Ostium primum defect''': Failure of the ostium primum to fuse with the endocardial cushions.<br />
<br />
* '''Superior sinus venosus defect''': The orifice of the superior vena cava overrides the atrial septum above the fossa ovalis.<br />
<br />
* '''Inferior sinus venosus defect''': The orifice of the inferior vena cava overrides the left and right atrium.<br />
*'''Coronary sinus defect''': Absence of a portion of the common wall that separates the coronary sinus and the left atrium.<br />
|<br />
* Continuous left-to-right shunt<br />
|<br />
* Failure to thrive, tachypnea, recurrent respiratory infections, heart failure<br />
<br />
* Commonly asymptomatic during childhood and adolescence<br />
*Adults with large shunts may become symptomatic in the fourth decade presenting with fatigue, exercise intolerance, palpitations, syncope, and shortness of breath.<br />
<br />
*<br />
|<br />
* TTE (Gold standard)<br />
*Cardiac CT<br />
*Cardiac MRI<br />
|<br />
* Hypermobile interatrial septum<br />
* Abrupt septal irregularity<br />
* Right atrial and ventricular volume overload<br />
* Pulmonary artery dilation<br />
*'''Coronary sinus defect''': Enlarged ostium of the coronary sinus and unroofing of the terminal portion of the coronary sinus<br />
|<br />
* Systolic flow murmur in the pulmonary valve region<br />
*Wide, fixed splitting of S2<br />
*Diastolic flow rumble across the tricuspid valve<br />
*Right ventricular heave <br />
|<br />
* Spontaneous closure<br />
*Percutaneous transcatheter closure<br />
*Surgical closure<br />
|<br />
* Right sided heart failure<br />
* Peripheral edema<br />
* Eisenmenger syndrome (cyanosis)<br />
* Paradoxical emboli<br />
* Pulmonary hypertension<br />
|-<br />
|Pulmonary ateriovenous fistula<br />
|<br />
* Abnormal blood vessel(s) connecting the pulmonary arteries and veins directly without interposition of pulmonary capillaries<br />
|<br />
* Right-to-left shunt between the pulmonary artery and pulmonary vein<br />
|<br />
* Symptoms may occur only after the second decade<br />
*Cyanosis<br />
*Hemoptysis<br />
|<br />
* Chest CT<br />
*Pulmonary arteriogram<br />
|<br />
* Appearance of contrast bubbles in the left atrium three to five cardiac cycles after appearance in the right atrium<br />
|<br />
* Clubbing<br />
*Systolic/continuous murmur<br />
|<br />
* Embolization<br />
* Surgical resection<br />
|<br />
* Cerebral ischemia/abscess<br />
*Hemothorax<br />
|}<br />
<br />
==Differential table for aortic stenosis==<br />
<br />
{| class="wikitable"<br />
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;|Diseases<br />
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;|History<br />
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;|Symptoms<br />
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;|Physical Examination<br />
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;|Murmur<br />
! colspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;|Diagnosis<br />
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;|Other Findings<br />
|- style="background: #DCDCDC; padding: 5px; text-align: center;"<br />
!style="background: #4479BA; color: #FFFFFF; text-align: center;|ECG<br />
!style="background: #4479BA; color: #FFFFFF; text-align: center;|CXR<br />
!style="background: #4479BA; color: #FFFFFF; text-align: center;|Echocardiogram<br />
!style="background: #4479BA; color: #FFFFFF; text-align: center;|Cardiac Catheterization<br />
|-<br />
|style="background: #DCDCDC; padding: 5px; text-align: center;" |Aortic stenosis<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Age (aortic valve calcification)<br />
*Syncope<br />
*Orthopnea<br />
*Paroxysmal nocturnal dyspnea<br />
*Acute rheumatic fever<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Chest pain<br />
*Dyspnea on exertion<br />
*Palpitations<br />
*Symptoms of heart failure<br />
| style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Pulsus parvus et tardus<br />
*Pulmonary rales<br />
*Peripheral edema (In CHF patients)<br />
*Jugular venous distension<br />
*Enlarged and laterally displaced point of maximal impulse<br />
<br />
*<br />
| style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Crescendo-decrescendo systolic murmur<br />
*Best heard at the right upper sternal border<br />
*Radiation to the carotid arteries<br />
*Increases with squatting<br />
*Decreases with valsalva maneuver<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Left ventricular hypertrophy''':<br />
<br />
* Wide QRS complex (especially in leads V1-V6)<br />
*ST depression in leads V5-V6<br />
*Left axis deviation<br />
* <br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Enlarged left ventricle<br />
* Enlarged left atrium and pulmonary artery in severe cases<br />
*Calcification of the aortic valve<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Thickening and calcification of the aortic valve<br />
*Left ventricular hypertrophy<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Left heart catheterization:'''<br />
<br />
* Left ventricular and aortic pressures<br />
*The left ventricle generates higher pressures than what is transmitted to the aorta<br />
| style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Associated with von Willibrand disease<br />
|-<br />
| colspan="10" |<br />
|-<br />
|style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Mitral Stenosis]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Age ( Mitral annular calcification in older patients)<br />
<br />
* [[Rheumatic fever]]<br />
<br />
* [[Endocarditis]]<br />
<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* [[Dyspnea on exertion]]<br />
<br />
* [[Paroxysmal nocturnal dyspnea]]<br />
<br />
* [[Orthopnea]]<br />
<br />
* New onset [[atrial fibrillation]]<br />
<br />
| style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Mitral facies<br />
<br />
* Heart murmur<br />
<br />
* [[JVD|Jugular vein distension]]<br />
<br />
* Apical impulse displaced laterally or not palpable <br />
<br />
* Diastolic thrill at the apex <br />
<br />
* Signs of heart failure in severe cases<br />
| style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Diastolic murmur<br />
<br />
* Low pitched<br />
<br />
* Opening snap followed by decrescendo-crescendo rumbling murmur <br />
<br />
* Best heard with the bell of the stethoscope at apex at end-expiration in left lateral decubitus position <br />
<br />
* Intensity increases after a [[valsalva maneuver]], after exercise and after increased after load (eg., squatting, isometric hand grip) <br />
| style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* [[P mitrale]]<br />
* [[Atrial fibrillation]]: No P waves and irregularly irregular rhythm<br />
<br />
* [[Right axis deviation]]<br />
<br />
* Right ventricular hypertropy: Dominant R wave in V1 and V2<br />
| style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Straightening of the left border of the heart suggestive of enlargement of the [[left atrium]]<br />
<br />
* Double right heart border (Enlarged left atrium and normal right atrium) <br />
<br />
* Prominent left atrial appendage<br />
<br />
* Splaying of [[carina|subcarinal angle]] (>120 degrees)<br />
<br />
* Calcification of [[mitral valve]]<br />
<br />
* [[Kerley B lines]] <br />
<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Reduced valve leaflet mobility<br />
<br />
* Valve calcification <br />
<br />
* Doming of mitral valve<br />
<br />
* Valve thickening <br />
* Enlargement of left atrium <br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Right heart catheterization:'''<br />
* [[Pulmonary capillary wedge pressure]] (left atrial pressure) <br />
'''Left heart catheterization:'''<br />
* Pressures in left ventricle<br />
<br />
* Determines the gradient between the left and right atrium during ventricular diastole (marker of the severity of mitral stenosis)<br />
<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* [[Hemoptysis]] ([[heart failure]])<br />
<br />
* [[Ortner's syndrome]]<br />
|-<br />
| colspan="10" |<br />
|-<br />
|style="vertical-align: top;background: #DCDCDC; padding: 5px; text-align: center;" |[[Mitral Regurgitation]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* [[CAD]]<br />
<br />
* [[MI]]<br />
<br />
* [[Rheumatic fever]]<br />
<br />
* [[Endocarditis]]<br />
<br />
* [[Mitral valve prolapse]]<br />
<br />
* [[Cardiomyopathy]]<br />
<br />
* [[Radiation therapy]]<br />
<br />
* Trauma<br />
<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* [[Palpitations]]<br />
<br />
* Symptoms of heart failure in severe cases<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Palpation'''<br />
* Brisk carotid upstroke and hyperdymanic carotid impulse on palpation<br />
<br />
* Apical impulse is displaced to left<br />
<br />
* S3 and a palpable thrill<br />
'''Auscultation'''<br />
* Murmur<br />
<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* [[Holosystolic murmur]]<br />
<br />
* High pitched, blowing<br />
<br />
* Radiates to axilla<br />
<br />
* Best heard with the diaphragm of the stethoscope at apex in left lateral [[decubitus]] position<br />
<br />
* Intensity increases with hand grip or squatting <br />
<br />
* Decrease in intensity on standing or [[valsalva maneuver]] <br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* [[P mitrale]] in lead II<br />
* Increased QRS voltage<br />
* [[Right axis deviation]]<br />
* [[Atrial fibrillation]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Acute MR'''<br />
* [[Kerley B lines]]<br />
* No enlargement of cardiac silhouette<br />
'''Chronic MR'''<br />
* Enlarged cardiac silhouette<br />
* Straightening of left heart border<br />
* Splaying of subcarinal angle<br />
* Calcification of mitral annulus<br />
* Double right heart border<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Enlargement of left atrium and ventricle<br />
* Identify valve abnormality<br />
* Valve calcification<br />
* Severity of regurgitation<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Grading of MR is done with left ventriculography<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Decompensated and acute MR may lead to [[heart failure]]<br />
|-<br />
| colspan="10" |<br />
|-<br />
|style="vertical-align: top;background: #DCDCDC; padding: 5px; text-align: center;" |[[Atrial septal defect]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Frequent respiratory or lung infections<br />
* [[Dyspnea]]<br />
* Tiring when feeding (Infants)<br />
* Shortness of breath on exertion<br />
* [[Palpitations]]<br />
* Swelling of feet<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* [[Shortness of breath]]<br />
* [[Fatigue]]<br />
* [[Failure to thrive]]<br />
* Swelling of feet and abdomen ([[Right heart failure]])<br />
* [[Palpitations]]<br />
* Respiratory infections<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Inspection'''<br />
* Precordial bulge<br />
* Precordial lift<br />
'''Palpation'''<br />
* Right ventricular impulse<br />
* Pulmonary artery pulsations<br />
* Thrill<br />
'''Auscultation'''<br />
* Murmur<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Midsystolic (ejection systolic) murmur<br />
<br />
* Widely split, fixed S2<br />
<br />
* Upper left sternal border<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Normal <br />
* Prolonged PR interval<br />
* [[Right bundle branch block]]<br />
* ECG findings varies according to the underlying type of ASD<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
*Increased pulmonary markings<br />
*[[Cardiomegaly]]<br />
*Triangular appearance of heart<br />
*Schimitar sign<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Gold standard test for diagnosis of atrial septal defect (for more information click [[Atrial septal defect echocardiography]])<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Defect size<br />
* Pulmonary venous return<br />
* [[Pulmonary vascular resistance]]<br />
* [[Pulmonary artery hypertension]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Asymptomatic until later part of their life<br />
* May be associated with [[migraine with aura]]<br />
|-<br />
| colspan="10" |<br />
|-<br />
|style="vertical-align: top;background: #DCDCDC; padding: 5px; text-align: center;" |[[Atrial myxoma|Left Atrial Myxoma]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* [[Dyspnea]]<br />
* [[Orthopnea]]<br />
* [[Pulmonary edema]]<br />
* Hyperpigmentation of skin and endocrine activity<br />
* Cerebral [[embolism]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Symptoms may mimic mitral stenosis<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Skin'''<br />
* Signs of an embolic phenomenon<br />
* [[Raynaud's phenomenon]]<br />
* Swelling<br />
* Clubbing<br />
'''Auscultation:'''<br />
* Lung: Fine crepitations <br />
<br />
* Heart: Characteristic "tumor plop" <br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Early diastolic sound as "tumor plop"<br />
<br />
* Low frequency diastolic murmur may be heard if the tumor obstructing mitral valve <br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Often normal<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Often normal<br />
'''Rare findings:'''<br />
* [[cardiomegaly]]<br />
* Left atrial enlargement<br />
* tumor calcification etc.,<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Initial and most useful diagnostic study<br />
* For more information click [[Myxoma echocardiography or ultrasound]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Useful to detect vascular supply of the tumor by the coronary arteries <br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Associated with Carney complex (genetic predisposition)<br />
|-<br />
| colspan="10" |<br />
|-<br />
|style="vertical-align: top;background: #DCDCDC; padding: 5px; text-align: center;" |Prosthetic Valve Obstruction<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* History of valve replacement<br />
* Systemic embolism<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Shortness of breath<br />
* Fatigue<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Ausculation'''<br />
<br />
Muffling of murmur<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Muffling or disappearance of prosthetic sounds<br />
<br />
* Appearance of new regurgitant or obstructive murmur <br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −<br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Degree of stenosis<br />
* Assess thrombus size and location<br />
* Differentiate between thrombus, [[pannus]] and vegetations<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |Causes:<br />
* Thrombus<br />
* Pannus formation<br />
|-<br />
| colspan="10" |<br />
|-<br />
|style="vertical-align: top;background: #DCDCDC; padding: 5px; text-align: center;" |[[Cor Triatriatum]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Dyspnea on exertion <br />
* Recent onset of [[congestive heart failure]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Dsypnea on exertion<br />
* Orthopnea<br />
* Tachypnea<br />
* Palpitations<br />
* Growth failure<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Auscultation'''<br />
* Murmur<br />
'''Other findings'''<br />
* Signs of heart failure<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Diastolic murmur with loud P2<br />
<br />
* No opening snap or a loud S1<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |Non specific but may have<br />
* [[Right axis deviation]]<br />
* Right atrial enlargement<br />
* [[Right ventricular hypertrophy]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Normal cardiac silhouette<br />
* Hemodynamic changes similar to mitral stenosis (non specific findings)<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Direct visualization of membrane through the atrium<br />
* +/- visualization of accessory chamber<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Normal left ventricular hemodynamic profile with a trans atrial gradient<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |Types<br />
* Cor triatriatum sinistrum<br />
* Cor triatriatum dextrum<br />
|-<br />
| colspan="10" |<br />
|-<br />
|style="vertical-align: top;background: #DCDCDC; padding: 5px; text-align: center;" |Congenital Mitral Stenosis<br />
| style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Respiratory distress shortly after birth<br />
* Recurrent severe pulmonary infections<br />
* Other associated congenital cardiovascular anamolies<br />
* [[Atrial fibrillation]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
<br />
'''Infants:'''<br />
* Exhaustion and sweating on feeding<br />
* Rapid breathing<br />
* [[Failure to thrive]]<br />
* Pulmonary infections <br />
* Chronic cough<br />
'''Older patients:'''<br />
* Dyspnea<br />
* Orthopnea<br />
* Paroxysmal nocturnal dyspnea<br />
* Peripheral edema<br />
* Fatigue<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Auscultation'''<br />
* Murmur<br />
'''Other findings'''<br />
* Signs of heart failure<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Mild-Moderate'''<br />
* Loud S1<br />
<br />
* Loud P2<br />
<br />
* Low frequency diastolic murmur best heard at the apex <br />
'''Severe'''<br />
* Soft S1<br />
<br />
* Loud pulmonic component of S2 with minimal respiratory splitting of S2 <br />
<br />
* Holodiastolic murmur with presystolic accentuation best heard at the apex <br />
<br />
* Early diastolic murmur of pulmonic valve regurgitation <br />
<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
*Sharp P waves in leads I and II<br />
*Inversion of P wave in lead III<br />
*Marked Q waves in leads II and III<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Left atrial dilation<br />
* Moderate enlargement of right heart<br />
* Pulmonary venous congestion<br />
* Esophageal compression<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Reduced valve leaflet mobility<br />
* Left atrial size<br />
* Severity of mitral stenosis<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |Very rare condition<br />
|-<br />
| colspan="10" |<br />
|-<br />
|style="vertical-align: top;background: #DCDCDC; padding: 5px; text-align: center;" |Supravalvular Ring Mitral Stenosis<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Other associated congenital heart defects<br />
* Fatigue<br />
* Frequent respiratory infections<br />
* Failure to thrive<br />
* Poor feeding<br />
* Precocious congestive heart failure <br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Shortness of breath<br />
<br />
* Tachypnea<br />
* Dyspnea<br />
* Nocturnal cough<br />
* Heamoptysis<br />
* [[Syncope]]<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Auscultation:'''<br />
<br />
Lungs: Fine, crepitant rales and rhonchi or wheezes may be present<br />
<br />
Heart: Murmur<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* An apical mid diastolic murmur with presystolic accentuation<br />
<br />
* No opening snap<br />
<br />
* The murmur is more prominent if associated with [[VSD]] or [[PDA]]<br />
<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Left atrial and ventricular enlargement<br />
* Alveolar edema <br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Supramitral ring''':<br />
* Associated with normal mitral valve apparatus<br />
'''Intramitral ring:'''<br />
* Hypomobility of the posterior leaflet<br />
* Reduced interpapillary muscle distance<br />
* Reduced chordal length<br />
* Dominant papillary muscle<br />
* Hypoplastic mitral annulus<br />
(Difficult to visualize membrane <1mm in size)<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |<br />
* Persistently elevated pulmonary venous pressures<br />
* Increased pulmonary artery pressure<br />
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Types'''<br />
* Supramitral<br />
* Intramitral<br />
It is attached between the opening of the atrial appendage and the mitral annulus which helps in differentiating with Cor triatriatum sinister.<br />
* Intramitral type is associated with shone complex<br />
|}</div>
Ifeoma odukwe
https://www.wikidoc.org/index.php?title=Sandbox:_ifrah&diff=1608341
Sandbox: ifrah
2020-05-15T17:12:55Z
<p>Ifeoma odukwe: Created page with "Ifrah fatima"</p>
<hr />
<div>Ifrah fatima</div>
Ifeoma odukwe