Aortic stenosis differential diagnosis: Difference between revisions
Usama Talib (talk | contribs) No edit summary |
Ahmed Younes (talk | contribs) No edit summary |
||
| Line 5: | Line 5: | ||
| [[Aortic stenosis resident survival guide|'''Resident'''<br>'''Survival'''<br>'''Guide''']] | | [[Aortic stenosis resident survival guide|'''Resident'''<br>'''Survival'''<br>'''Guide''']] | ||
|} | |} | ||
[[Image:Home_logo1.png|right|250px|link=http://www.wikidoc.org/index.php/Aortic_stenosis]] | |||
{{CMG}}; '''Associate Editors-In-Chief:''' [[User:Mohammed Sbeih|Mohammed A. Sbeih, M.D.]] [mailto:msbeih@wikidoc.org]; {{USAMA}} '''Assistant Editor-In-Chief:''' [[Kristin Feeney|Kristin Feeney, B.S.]] [mailto:kfeeney@elon.edu] | {{CMG}}; '''Associate Editors-In-Chief:''' [[User:Mohammed Sbeih|Mohammed A. Sbeih, M.D.]] [mailto:msbeih@wikidoc.org]; {{USAMA}} '''Assistant Editor-In-Chief:''' [[Kristin Feeney|Kristin Feeney, B.S.]] [mailto:kfeeney@elon.edu] | ||
Revision as of 19:03, 7 March 2019
 |
Resident Survival Guide |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editors-In-Chief: Mohammed A. Sbeih, M.D. [2]; Usama Talib, BSc, MD [3] Assistant Editor-In-Chief: Kristin Feeney, B.S. [4]
Overview
Aortic stenosis must be differentiated from other cardiac or pulmonary causes of dyspnea, weakness, and dizziness. Furthermore, when left ventricular outflow tract obstruction is present, it is critical to identify whether the obstruction is subvalvular, valvular or supravalvular and whether there is hypertrophic cardiomyopathy (HOCM) or not.[1]
Differentiating Aortic Stenosis from other Diseases
Pulmonary Causes of Dyspnea
Aortic stenosis can be differentiated from pulmonary causes of dyspnea by the presence of:
- A narrow pulse pressure
- A harsh late-peaking systolic murmur heard best at the right second intercostal space with radiation to the carotid arteries
- A delayed slow-rising carotid upstroke (pulsus parvus et tardus) [2]
- Signs of heart failure on examination
Aortic Sclerosis
While a murmur may be heard in aortic sclerosis, there is no fusion of the commisures and no significant obstruction to antegrade blood flow across the aortic valve. As a result, the S2 is normal in aortic sclerosis and the carotid upstroke is normal (i.e. pulsus parvus et tardus is absent).[3]
Mitral Regurgitation
The murmur of aortic stenosis is harsh and best heard at the right second intercostal space while the murmur of mitral regurgitation is blowing, soft and best heard at the apex.[4]
Hypertrophic Obstructive Cardiomyopathy
In HOCM the murmur is dynamic and varies with maneuvers. Moreover, there is a bifid or spoke and dome pattern of the carotid upstroke.[5]
Valvular, Subvalvular and Supravalvular Aortic Stenosis
Differentiating Valvular Aortic Stenosis from Subvalvular Aortic Stenosis
Aortic insufficiency is more often present with subvalvular aortic stenosis (in 50% to 75% of cases). Symptoms associated with subvalvular aortic stenosis begin earlier in life (in childhood or adolescence) than symptoms associated with valvular aortic stenosis.[6]
Differentiating Valvular Aortic Stenosis from Supravalvular Aortic Stenosis
Supravalvular aortic stenosis is an uncommon congenital anomaly caused by a narrowing in the ascending aorta or by the presence of a fibrous diaphragm just above the aortic valve. It presents in early adulthood. Although the aortic valve is not stenotic, doppler shows an increased pressure gradient. 50% of patients with supravalvular aortic stenosis have a characteristically greater pulse and systolic blood pressure in the right carotid and brachial arteries than in the left. The systolic murmur is maximal below the right clavicle and radiates primarily to the right carotid artery. There is not an ejection click nor a diastolic murmur.[6]
References
- ↑ Cleland JG, Swedberg K, Follath F, Komajda M, Cohen-Solal A, Aguilar JC, Dietz R, Gavazzi A, Hobbs R, Korewicki J, Madeira HC, Moiseyev VS, Preda I, van Gilst WH, Widimsky J, Freemantle N, Eastaugh J, Mason J (2003). "The EuroHeart Failure survey programme-- a survey on the quality of care among patients with heart failure in Europe. Part 1: patient characteristics and diagnosis". European Heart Journal. 24 (5): 442–63. PMID 12633546. Retrieved 2012-04-11. Unknown parameter
|month=ignored (help) - ↑ Toy, Eugene, et al. Case Files: Internal Medicine. McGraw-Hill Companies, Inc. 2007. Page 43. ISBN 0071463038.
- ↑ Lucena CM, Santos RP (2015). "Association between Aortic Valve Sclerosis and Adverse Cardiovascular Events". Arq Bras Cardiol. 105 (1): 99. doi:10.5935/abc.20150081. PMC 4523295. PMID 26270071.
- ↑ Mirabel M, Iung B, Baron G, Messika-Zeitoun D, Détaint D, Vanoverschelde JL; et al. (2007). "What are the characteristics of patients with severe, symptomatic, mitral regurgitation who are denied surgery?". Eur Heart J. 28 (11): 1358–65. doi:10.1093/eurheartj/ehm001. PMID 17350971.
- ↑ Veselka J, Anavekar NS, Charron P (2016). "Hypertrophic obstructive cardiomyopathy". Lancet. doi:10.1016/S0140-6736(16)31321-6. PMID 27912983.
- ↑ 6.0 6.1 Roberts WC (1973). "Valvular, subvalvular and supravalvular aortic stenosis: morphologic features". Cardiovasc Clin. 5 (1): 97–126. PMID 4272665.