Congenital cyanotic heart disease: Difference between revisions

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== Overview ==
== Overview ==
Congenital cyanotic heart disease is a group of heart defects that will causes neonatal cyanosis. The patient appears blue ([[Cyanosis|cyanotic]]), due to deoxygenated [[blood]] bypassing the [[Lung|lungs]] and entering the [[systemic circulation]]. This can be caused by [[Right-to-left shunt|right-to-left]] or [[Bidirectional shunt|bidirectional]] [[Shunt (medical)|shunting]], or malposition of the [[great arteries]]. Such defects include [[persistent truncus arteriosus]], [[total anomalous pulmonary venous connection]], [[tetralogy of Fallot]], [[transposition of the great vessels]], and [[Ebstein's anomaly]].


== Classification ==
== Classification ==
Congenital cyanotic heart disease may be classified according to anatomical defect into 5 subgroups:


* Tetralogy of fallot
== Causes ==
**It is understood that tetralogy of fallot is the result of improper positioning of the outlet [[septum]].<ref name="pmid19094375">{{cite journal| author=Anderson RH, Jacobs ML| title=The anatomy of tetralogy of Fallot with pulmonary stenosis. | journal=Cardiol Young | year= 2008 | volume= 18 Suppl 3 | issue=  | pages= 12-21 | pmid=19094375 | doi=10.1017/S1047951108003259 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19094375  }}</ref><ref name="pmid17420363">{{cite journal| author=Bashore TM| title=Adult congenital heart disease: right ventricular outflow tract lesions. | journal=Circulation | year= 2007 | volume= 115 | issue= 14 | pages= 1933-47 | pmid=17420363 | doi=10.1161/CIRCULATIONAHA.105.592345 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17420363  }}</ref><ref name="pmid19144126">{{cite journal| author=Bailliard F, Anderson RH| title=Tetralogy of Fallot. | journal=Orphanet J Rare Dis | year= 2009 | volume= 4 | issue=  | pages= 2 | pmid=19144126 | doi=10.1186/1750-1172-4-2 | pmc=PMC2651859 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19144126  }}</ref>
**In the normal [[heart]], the outlet septum is an indistinguishable component of the crista supraventricularis that communicates with the [[Septomarginal trabecula|septomarginal trabeculae]] to divide the [[Right ventricle|right]] and [[Left ventricle|left]] [[Ventricle|ventricular cavities]].
**In Tetralogy of Fallot, proper [[Ventricle (heart)|ventricular]] septation is perturbed by anterocephalad displacement of the outlet [[Septum (disambiguation)|septum]] relative to the [[septomarginal trabecula]].
**The direct consequence of this misalignment is an [[Overriding aorta|overriding aortic orifice]] and a [[ventricular septal defect]], resulting in an intracardiac [[Right-to-left shunt|right to left shunt]] of blood.
**In addition, anterocephalad displacement of the outlet septum indirectly predisposes the [[pulmonary trunk]] to [[Pulmonary stenosis|stenosis]] in the setting of septoparietal trabecular [[hypertrophy]].
**Together, the displacement of the outlet [[septum]] coupled with the [[Hypertrophy (medical)|hypertrophic]] arrangement of the septoparietal trabeculae account for the three [[Anatomy|anatomical]] cardinal [[Defect|defects]] in Tetralogy of Fallot - [[Aorta|aortic]] dextroposition, [[Ventricular septal defect|interventricular communication]] ([[VSD]]), and [[pulmonary stenosis]].
**The fourth [[defect]] - [[right ventricular hypertrophy]] - is a [[hemodynamic]] consequence of these three [[Morphology|morphologic]] changes, as the [[right ventricle]] physiologically adapts to the increased [[resistance]] of a [[Pulmonary stenosis|stenotic pulmonary trunk]].
* Total anomalous pulmonary venous connection
**n this condition,the right side of heart is receiving blood both from pulmonary and systemic circulation.<ref name="pmid13378917">{{cite journal |vauthors=NEILL CA |title=Development of the pulmonary veins; with reference to the embryology of anomalies of pulmonary venous return |journal=Pediatrics |volume=18 |issue=6 |pages=880–7 |date=December 1956 |pmid=13378917 |doi= |url=}}</ref><ref name="pmid13386206">{{cite journal |vauthors=CRAIG JM, DARLING RC, ROTHNEY WB |title=Total pulmonary venous drainage into the right side of the heart; report of 17 autopsied cases not associated with other major cardiovascular anomalies |journal=Lab. Invest. |volume=6 |issue=1 |pages=44–64 |date=1957 |pmid=13386206 |doi= |url=}}</ref>
**There is a mixing of oxygenated pulmonary venous blood with deoxygenated blood from systemic circulation.
** The mixing of blood could occur at three levels i.e. supracardiac, infracardiac and cardiac.
**In the former two the mixing occurs outside the heart and in latter inside the heart (right atrium)
* Transposition of the great arteries
* Truncus arteriosus
* Ebstein's anomaly


== Differential diagnosis ==
== Differential diagnosis ==
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! rowspan="20" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Pulmonary disease|Pulmonary diseases]]
! rowspan="20" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Pulmonary disease|Pulmonary diseases]]
! rowspan="7" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Airway]] disorder
! rowspan="7" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Airway]] disorder
! colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Severe [[croup]]
! colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Severe [[croup]]<ref name="Cherry20082">{{cite journal|last1=Cherry|first1=James D.|title=Croup|journal=New England Journal of Medicine|volume=358|issue=4|year=2008|pages=384–391|issn=0028-4793|doi=10.1056/NEJMcp072022}}</ref>
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| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
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| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Intercostal]] and [[subcostal]] [[retraction]], [[Barking cough]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Intercostal]] and [[subcostal]] [[retraction]], [[Barking cough]]
|-
|-
! colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Epiglottitis]]
! colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Epiglottitis]]<ref name="pmid23162404">{{cite journal| author=Abdallah C| title=Acute epiglottitis: Trends, diagnosis and management. | journal=Saudi J Anaesth | year= 2012 | volume= 6 | issue= 3 | pages= 279-81 | pmid=23162404 | doi=10.4103/1658-354X.101222 | pmc=3498669 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23162404  }}</ref>
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| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Muffled voice, [[Drooling]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Muffled voice, [[Drooling]]
|-
|-
! colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Foreign body aspiration]]
! colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Foreign body aspiration]]<ref name="pmid18682760">{{cite journal| author=Qureshi A, Behzadi A| title=Foreign-body aspiration in an adult. | journal=Can J Surg | year= 2008 | volume= 51 | issue= 3 | pages= E69-70 | pmid=18682760 | doi= | pmc=2496600 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18682760  }}</ref>
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| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Mediastinitis]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Mediastinitis]]
|-
|-
! colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Bacterial tracheitis]]
! colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Bacterial tracheitis]]<ref name="pmid6869336">{{cite journal |vauthors=Liston SL, Gehrz RC, Siegel LG, Tilelli J |title=Bacterial tracheitis |journal=Am. J. Dis. Child. |volume=137 |issue=8 |pages=764–7 |date=August 1983 |pmid=6869336 |doi= |url=}}</ref>
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| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Brassy [[cough]], [[Hoarseness]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Brassy [[cough]], [[Hoarseness]]
|-
|-
! style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Sleep apnea]]
! style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Sleep apnea]]<ref name="pmid26336596">{{cite journal| author=Spicuzza L, Caruso D, Di Maria G| title=Obstructive sleep apnoea syndrome and its management. | journal=Ther Adv Chronic Dis | year= 2015 | volume= 6 | issue= 5 | pages= 273-85 | pmid=26336596 | doi=10.1177/2040622315590318 | pmc=4549693 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26336596  }}</ref>
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
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| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Nightmares]], [[Snoring]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Nightmares]], [[Snoring]]
|-
|-
! style="padding: 5px 5px; background: #DCDCDC;" align="center" |Chronic [[bronchitis]]
! style="padding: 5px 5px; background: #DCDCDC;" align="center" |Chronic [[bronchitis]]<ref name="pmid23204254">{{cite journal| author=Kim V, Criner GJ| title=Chronic bronchitis and chronic obstructive pulmonary disease. | journal=Am J Respir Crit Care Med | year= 2013 | volume= 187 | issue= 3 | pages= 228-37 | pmid=23204254 | doi=10.1164/rccm.201210-1843CI | pmc=4951627 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23204254  }}</ref>
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
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| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Productive cough]], [[Chest tightness]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Productive cough]], [[Chest tightness]]
|-
|-
! style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Atelectasis]]
! style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Atelectasis]]<ref name="pmid12531090">{{cite journal |vauthors=Peroni DG, Boner AL |title=Atelectasis: mechanisms, diagnosis and management |journal=Paediatr Respir Rev |volume=1 |issue=3 |pages=274–8 |date=September 2000 |pmid=12531090 |doi=10.1053/prrv.2000.0059 |url=}}</ref>
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|-
|-
! rowspan="10" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Parenchymal lung disease|Parenchymal disorder]]
! rowspan="10" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Parenchymal lung disease|Parenchymal disorder]]
! style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Alveolitis]]
! style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Alveolitis]]<ref name="pmid1620846">{{cite journal |vauthors=Lee JS, Im JG, Ahn JM, Kim YM, Han MC |title=Fibrosing alveolitis: prognostic implication of ground-glass attenuation at high-resolution CT |journal=Radiology |volume=184 |issue=2 |pages=451–4 |date=August 1992 |pmid=1620846 |doi=10.1148/radiology.184.2.1620846 |url=}}</ref>
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +/-
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +/-
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
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| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Malaise]], [[Chills]], [[Headache]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Malaise]], [[Chills]], [[Headache]]
|-
|-
! colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Pneumonia]]
! colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Pneumonia]]<ref name="pmid25165554">{{cite journal| author=Simonetti AF, Viasus D, Garcia-Vidal C, Carratalà J| title=Management of community-acquired pneumonia in older adults. | journal=Ther Adv Infect Dis | year= 2014 | volume= 2 | issue= 1 | pages= 3-16 | pmid=25165554 | doi=10.1177/2049936113518041 | pmc=4072047 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25165554  }}</ref>
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
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| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Tachycardia]], [[Bradycardia]] ([[Legionella]])
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Tachycardia]], [[Bradycardia]] ([[Legionella]])
|-
|-
! colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Asthma]] (Late)
! colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Asthma]] (Late)<ref name="pmid19365260">{{cite journal |vauthors=Litonjua AA |title=Childhood asthma may be a consequence of vitamin D deficiency |journal=Curr Opin Allergy Clin Immunol |volume=9 |issue=3 |pages=202–7 |date=June 2009 |pmid=19365260 |doi=10.1097/ACI.0b013e32832b36cd |url=}}</ref>
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
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| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Triad of [[asthma]], [[nasal polyps]], and [[rash]] is indicative of [[Aspirin desensitization|aspirin sensitivity]].
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Triad of [[asthma]], [[nasal polyps]], and [[rash]] is indicative of [[Aspirin desensitization|aspirin sensitivity]].
|-
|-
! colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Cystic fibrosis]]
! colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Cystic fibrosis]]<ref name="urlCystic fibrosis - Genetics Home Reference">{{cite web |url=https://ghr.nlm.nih.gov/condition/cystic-fibrosis |title=Cystic fibrosis - Genetics Home Reference |format= |work= |accessdate=}}</ref>
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|-
|-
! colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[COPD]]
! colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[COPD]]
(Severe [[emphysema]])
(Severe [[emphysema]])<ref name="pmid25177479">{{cite journal| author=Qureshi H, Sharafkhaneh A, Hanania NA| title=Chronic obstructive pulmonary disease exacerbations: latest evidence and clinical implications. | journal=Ther Adv Chronic Dis | year= 2014 | volume= 5 | issue= 5 | pages= 212-27 | pmid=25177479 | doi=10.1177/2040622314532862 | pmc=4131503 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25177479  }}</ref>
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
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| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Pulmonary hypertension]], [[Right heart failure]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Pulmonary hypertension]], [[Right heart failure]]
|-
|-
! colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Tuberculosis]]
! colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Tuberculosis]]<ref name="OlalekanOluwaseun2015">{{cite journal|last1=Olalekan|first1=Adebimpe Wasiu|last2=Oluwaseun|first2=Faremi Ayodeji|last3=Oladele|first3=Hassan Abdul-Wasiu|last4=Akeem|first4=Adeyemi Damilare|title=Evaluation of electrolyte imbalance among tuberculosis patients receiving treatments in Southwestern Nigeria|journal=Alexandria Journal of Medicine|volume=51|issue=3|year=2015|pages=255–260|issn=20905068|doi=10.1016/j.ajme.2014.10.003}}</ref>
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| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Loss of appetite]], [[Night sweats]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Loss of appetite]], [[Night sweats]]
|-
|-
! colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Pulmonary fibrosis]]
! colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Pulmonary fibrosis]]<ref name="pmid29268540">{{cite journal| author=Shaw J, Marshall T, Morris H, Hayton C, Chaudhuri N| title=Idiopathic pulmonary fibrosis: a holistic approach to disease management in the antifibrotic age. | journal=J Thorac Dis | year= 2017 | volume= 9 | issue= 11 | pages= 4700-4707 | pmid=29268540 | doi=10.21037/jtd.2017.10.111 | pmc=5721024 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29268540  }}</ref>
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
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| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Fatigue]], [[Weight loss]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Fatigue]], [[Weight loss]]
|-
|-
! colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Pneumoconiosis]]
! colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Pneumoconiosis]]<ref name="pmid27336897">{{cite journal| author=Yen CM, Lin CL, Lin MC, Chen HY, Lu NH, Kao CH| title=Pneumoconiosis increases the risk of congestive heart failure: A nationwide population-based cohort study. | journal=Medicine (Baltimore) | year= 2016 | volume= 95 | issue= 25 | pages= e3972 | pmid=27336897 | doi=10.1097/MD.0000000000003972 | pmc=4998335 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27336897  }}</ref>
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
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| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Tightness in the [[chest]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Tightness in the [[chest]]
|-
|-
! colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Lung cancer]]
! colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Lung cancer]]<ref name="pmid20493989">{{cite journal |vauthors=Hartwig MG, D'Amico TA |title=Thoracoscopic lobectomy: the gold standard for early-stage lung cancer? |journal=Ann. Thorac. Surg. |volume=89 |issue=6 |pages=S2098–101 |date=June 2010 |pmid=20493989 |doi=10.1016/j.athoracsur.2010.02.102 |url=}}</ref>
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| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Weight loss]], [[Loss of appetite]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Weight loss]], [[Loss of appetite]]
|-
|-
! colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Acute respiratory distress syndrome]]
! colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Acute respiratory distress syndrome]]<ref name="pmid26045965">{{cite journal| author=Ochiai R| title=Mechanical ventilation of acute respiratory distress syndrome. | journal=J Intensive Care | year= 2015 | volume= 3 | issue= 1 | pages= 25 | pmid=26045965 | doi=10.1186/s40560-015-0091-6 | pmc=4456061 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26045965  }}</ref>
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
Line 395: Line 378:
|-
|-
! rowspan="3" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Pulmonary vascular congestion|Pulmonary vascular disorders]]
! rowspan="3" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Pulmonary vascular congestion|Pulmonary vascular disorders]]
! colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Massive [[pulmonary embolism]]
! colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Massive [[pulmonary embolism]]<ref name="pmid23940438">{{cite journal| author=Bĕlohlávek J, Dytrych V, Linhart A| title=Pulmonary embolism, part I: Epidemiology, risk factors and risk stratification, pathophysiology, clinical presentation, diagnosis and nonthrombotic pulmonary embolism. | journal=Exp Clin Cardiol | year= 2013 | volume= 18 | issue= 2 | pages= 129-38 | pmid=23940438 | doi= | pmc=3718593 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23940438  }}</ref>
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
Line 414: Line 397:
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Tachycardia]], [[Shock]], [[Pulmonary hypertension]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Tachycardia]], [[Shock]], [[Pulmonary hypertension]]
|-
|-
! style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Pulmonary arterio-venous malformation]]
! style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Pulmonary arterio-venous malformation]]<ref name="pmid119300212">{{cite journal |vauthors=Khurshid I, Downie GH |title=Pulmonary arteriovenous malformation |journal=Postgrad Med J |volume=78 |issue=918 |pages=191–7 |year=2002 |pmid=11930021 |pmc=1742331 |doi= |url=}}</ref><ref name="pmid195683982">{{cite journal |vauthors=Doshi HM, Robinson S, Chalhoub T, Jack S, Denison A, Gibson G |title=Massive spontaneous hemothorax during the immediate postpartum period |journal=Tex Heart Inst J |volume=36 |issue=3 |pages=247–9 |year=2009 |pmid=19568398 |pmc=2696501 |doi= |url=}}</ref><ref name="pmid15541322">{{cite journal |vauthors=Chanatry BJ |title=Acute hemothorax owing to pulmonary arteriovenous malformation in pregnancy |journal=Anesth. Analg. |volume=74 |issue=4 |pages=613–5 |year=1992 |pmid=1554132 |doi= |url=}}</ref>
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
Line 433: Line 416:
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Cerebral arteriovenous malformation]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Cerebral arteriovenous malformation]]
|-
|-
! colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Pulmonary hypertension]]
! colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Pulmonary hypertension]]<ref name="pmid28241922">{{cite journal| author=Hoeper MM, Ghofrani HA, Grünig E, Klose H, Olschewski H, Rosenkranz S| title=Pulmonary Hypertension. | journal=Dtsch Arztebl Int | year= 2017 | volume= 114 | issue= 5 | pages= 73-84 | pmid=28241922 | doi=10.3238/arztebl.2017.0073 | pmc=5331483 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28241922  }}</ref>
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
Line 455: Line 438:
|-
|-
! colspan="2" rowspan="2" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Chest wall deformities|Chest wall disorders]]
! colspan="2" rowspan="2" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Chest wall deformities|Chest wall disorders]]
! style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Flail chest]]
! style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Flail chest]]<ref name="pmid17650694">{{cite journal |vauthors=Pettiford BL, Luketich JD, Landreneau RJ |title=The management of flail chest |journal=Thorac Surg Clin |volume=17 |issue=1 |pages=25–33 |date=February 2007 |pmid=17650694 |doi=10.1016/j.thorsurg.2007.02.005 |url=}}</ref>
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
Line 474: Line 457:
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Bruises]] over [[chest]]  
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Bruises]] over [[chest]]  
|-
|-
! style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Pneumothorax]]
! style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Pneumothorax]]<ref name="pmid20872980">{{cite journal| author=Luh SP| title=Review: Diagnosis and treatment of primary spontaneous pneumothorax. | journal=J Zhejiang Univ Sci B | year= 2010 | volume= 11 | issue= 10 | pages= 735-44 | pmid=20872980 | doi=10.1631/jzus.B1000131 | pmc=2950234 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20872980  }}</ref>
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
Line 514: Line 497:
! rowspan="15" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Cardiac disease|Cardiac diseases]]
! rowspan="15" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Cardiac disease|Cardiac diseases]]
! rowspan="8" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Congenital disorder|Congenital disorders]]
! rowspan="8" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Congenital disorder|Congenital disorders]]
! colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Atrioventricular canal defect (patient information)|Atrioventricular canal defect]]
! colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Atrioventricular canal defect (patient information)|Atrioventricular canal defect]]<ref name="pmid15227445">{{cite journal| author=Macris MP, Ott DA, Cooley DA| title=Complete atrioventricular canal defect: surgical considerations. | journal=Tex Heart Inst J | year= 1992 | volume= 19 | issue= 3 | pages= 239-43 | pmid=15227445 | doi= | pmc=326195 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15227445  }}</ref>
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +/-
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +/-
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
Line 533: Line 516:
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Tachypnea]], Lack of [[appetite]], [[Pale skin color]], Excessive [[sweating]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Tachypnea]], Lack of [[appetite]], [[Pale skin color]], Excessive [[sweating]]
|-
|-
! style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Ebstein anomaly]]
! style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Ebstein anomaly]]<ref name="pmid27439413">{{cite journal |vauthors=Safi LM, Liberthson RR, Bhatt A |title=Current Management of Ebstein's Anomaly in the Adult |journal=Curr Treat Options Cardiovasc Med |volume=18 |issue=9 |pages=56 |date=September 2016 |pmid=27439413 |doi=10.1007/s11936-016-0478-2 |url=}}</ref>
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
Line 552: Line 535:
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Fatigue]], [[Palpitations]]  
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Fatigue]], [[Palpitations]]  
|-
|-
! style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Tetralogy of Fallot]]
! style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Tetralogy of Fallot]]<ref name="pmid19144126">{{cite journal| author=Bailliard F, Anderson RH| title=Tetralogy of Fallot. | journal=Orphanet J Rare Dis | year= 2009 | volume= 4 | issue=  | pages= 2 | pmid=19144126 | doi=10.1186/1750-1172-4-2 | pmc=2651859 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19144126  }}</ref>
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
Line 571: Line 554:
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Fainting]], [[Palpitation]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Fainting]], [[Palpitation]]
|-
|-
! style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Pulmonic stenosis]]
! style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Pulmonic stenosis]]<ref name="pmid23807889">{{cite journal| author=Yoo BW, Park HK| title=Pulmonary stenosis and pulmonary regurgitation: both ends of the spectrum in residual hemodynamic impairment after tetralogy of Fallot repair. | journal=Korean J Pediatr | year= 2013 | volume= 56 | issue= 6 | pages= 235-41 | pmid=23807889 | doi=10.3345/kjp.2013.56.6.235 | pmc=3693041 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23807889  }}</ref>
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
Line 590: Line 573:
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Fainting]], [[Palpitation]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Fainting]], [[Palpitation]]
|-
|-
! style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Total anomalous pulmonary venous drainage|Total anomalous pulmonary]] [[Total anomalous pulmonary venous drainage|venous connection]]
! style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Total anomalous pulmonary venous drainage|Total anomalous pulmonary]] [[Total anomalous pulmonary venous drainage|venous connection]]<ref name="pmid17352891">{{cite journal |vauthors=Stein P |title=Total anomalous pulmonary venous connection |journal=AORN J |volume=85 |issue=3 |pages=509–20; quiz 521–4 |date=March 2007 |pmid=17352891 |doi=10.1016/S0001-2092(07)60123-9 |url=}}</ref>
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
Line 609: Line 592:
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Pounding [[heart]], Weak [[pulse]], Extreme [[sleepiness]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Pounding [[heart]], Weak [[pulse]], Extreme [[sleepiness]]
|-
|-
! style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Transposition of the great vessels]]
! style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Transposition of the great vessels]]<ref name="pmid18851735">{{cite journal| author=Martins P, Castela E| title=Transposition of the great arteries. | journal=Orphanet J Rare Dis | year= 2008 | volume= 3 | issue=  | pages= 27 | pmid=18851735 | doi=10.1186/1750-1172-3-27 | pmc=2577629 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18851735  }}</ref>
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
Line 628: Line 611:
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Lack of appetite]], [[Poor weight gain]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Lack of appetite]], [[Poor weight gain]]
|-
|-
! style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Truncus arteriosus]]
! style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Truncus arteriosus]]<ref name="pmid2856609">{{cite journal |vauthors=Van Praagh R |title=Truncus arteriosus: what is it really and how should it be classified? |journal=Eur J Cardiothorac Surg |volume=1 |issue=2 |pages=65–70 |date=1987 |pmid=2856609 |doi= |url=}}</ref>
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
Line 647: Line 630:
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Fatigue]], [[Sweating]], [[Pale skin|Pale]] or cool [[skin]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Fatigue]], [[Sweating]], [[Pale skin|Pale]] or cool [[skin]]
|-
|-
! colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Patent ductus arteriosus]]
! colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Patent ductus arteriosus]]<ref name="urlPatent Ductus Arteriosus - National Library of Medicine - PubMed Health">{{cite web |url=https://www.ncbi.nlm.nih.gov/pubmedhealth/PMHT0023293/. |title=Patent Ductus Arteriosus - National Library of Medicine - PubMed Health |format= |work= |accessdate=}}</ref>
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
Line 667: Line 650:
|-
|-
! rowspan="7" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Acquired disorder|Acquired disorders]]
! rowspan="7" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Acquired disorder|Acquired disorders]]
! style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Heart failure]]
! style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Heart failure]]<ref name="pmid27367736">{{cite journal| author=Inamdar AA, Inamdar AC| title=Heart Failure: Diagnosis, Management and Utilization. | journal=J Clin Med | year= 2016 | volume= 5 | issue= 7 | pages=  | pmid=27367736 | doi=10.3390/jcm5070062 | pmc=4961993 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27367736  }}</ref>
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
Line 686: Line 669:
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Generalized edema]], [[Hepatomegaly]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Generalized edema]], [[Hepatomegaly]]
|-
|-
! style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Valvular heart disease]]
! style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Valvular heart disease]]<ref name="pmid20435842">{{cite journal| author=Maganti K, Rigolin VH, Sarano ME, Bonow RO| title=Valvular heart disease: diagnosis and management. | journal=Mayo Clin Proc | year= 2010 | volume= 85 | issue= 5 | pages= 483-500 | pmid=20435842 | doi=10.4065/mcp.2009.0706 | pmc=2861980 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20435842  }}</ref>
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
Line 705: Line 688:
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Syncope]], [[Palpitation]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Syncope]], [[Palpitation]]
|-
|-
! style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Myocardial infarction]]
! style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Myocardial infarction]]<ref name="urlMyocardial Infarction (Heart Attack): Symptoms - National Library of Medicine - PubMed Health">{{cite web |url=https://www.ncbi.nlm.nih.gov/pubmedhealth/PMHT0023216/ |title=Myocardial Infarction (Heart Attack): Symptoms - National Library of Medicine - PubMed Health |format= |work= |accessdate=}}</ref>
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
Line 724: Line 707:
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Dizziness]], [[Fatigue]], [[Lightheadedness]], [[Cold sweat]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Dizziness]], [[Fatigue]], [[Lightheadedness]], [[Cold sweat]]
|-
|-
! colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Cardiogenic shock]]
! colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Cardiogenic shock]]<ref name="pmid22675405">{{cite journal| author=Werdan K, Ruß M, Buerke M, Delle-Karth G, Geppert A, Schöndube FA et al.| title=Cardiogenic shock due to myocardial infarction: diagnosis, monitoring and treatment: a German-Austrian S3 Guideline. | journal=Dtsch Arztebl Int | year= 2012 | volume= 109 | issue= 19 | pages= 343-51 | pmid=22675405 | doi=10.3238/arztebl.2012.0343 | pmc=3364528 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22675405  }}</ref>
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +/-
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +/-
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
Line 743: Line 726:
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Tachypnea]], [[Palpitation]], [[Hypotension]], Weak [[pulse]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Tachypnea]], [[Palpitation]], [[Hypotension]], Weak [[pulse]]
|-
|-
! colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Cardiomyopathy]]
! colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Cardiomyopathy]]<ref name="pmid28912181">{{cite journal |vauthors=Marian AJ, Braunwald E |title=Hypertrophic Cardiomyopathy: Genetics, Pathogenesis, Clinical Manifestations, Diagnosis, and Therapy |journal=Circ. Res. |volume=121 |issue=7 |pages=749–770 |date=September 2017 |pmid=28912181 |doi=10.1161/CIRCRESAHA.117.311059 |url=}}</ref>
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
Line 762: Line 745:
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Arrhythmias|Arrhythmia]], [[Bloating]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Arrhythmias|Arrhythmia]], [[Bloating]]
|-
|-
! colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Heart tumors]]
! colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Heart tumors]]<ref name="pmid24717305">{{cite journal| author=Hoffmeier A, Sindermann JR, Scheld HH, Martens S| title=Cardiac tumors--diagnosis and surgical treatment. | journal=Dtsch Arztebl Int | year= 2014 | volume= 111 | issue= 12 | pages= 205-11 | pmid=24717305 | doi=10.3238/arztebl.2014.0205 | pmc=3983698 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24717305  }}</ref>
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
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| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Syncope]], [[Weight loss]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Syncope]], [[Weight loss]]
|-
|-
! colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Mitral Stenosis]]
! colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Mitral Stenosis]]<ref name="pmid21189882">{{cite journal| author=Kannan M, Vijayanand G| title=Mitral stenosis and pregnancy: Current concepts in anaesthetic practice. | journal=Indian J Anaesth | year= 2010 | volume= 54 | issue= 5 | pages= 439-44 | pmid=21189882 | doi=10.4103/0019-5049.71043 | pmc=2991654 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21189882  }}</ref>
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
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! rowspan="5" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Vascular disease]]
! rowspan="5" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Vascular disease]]
! rowspan="3" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Arterial Insufficiency|Arterial disorders]]
! rowspan="3" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Arterial Insufficiency|Arterial disorders]]
! style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Ddx:Acrocyanosis|Acrocyanosis]]
! style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Ddx:Acrocyanosis|Acrocyanosis]]<ref name="pmid24249890">{{cite journal| author=Das S, Maiti A| title=Acrocyanosis: an overview. | journal=Indian J Dermatol | year= 2013 | volume= 58 | issue= 6 | pages= 417-20 | pmid=24249890 | doi=10.4103/0019-5154.119946 | pmc=3827510 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24249890  }}</ref>
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
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| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Brittle nails]], [[Telangiectasia]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Brittle nails]], [[Telangiectasia]]
|-
|-
! colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Arterial embolism]]
! colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Arterial embolism]]<ref name="pmid23724391">{{cite journal| author=Lyaker MR, Tulman DB, Dimitrova GT, Pin RH, Papadimos TJ| title=Arterial embolism. | journal=Int J Crit Illn Inj Sci | year= 2013 | volume= 3 | issue= 1 | pages= 77-87 | pmid=23724391 | doi=10.4103/2229-5151.109429 | pmc=3665125 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23724391  }}</ref>
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
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| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Headache]], Decreased [[sensation]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Headache]], Decreased [[sensation]]
|-
|-
! colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Raynaud's Phenomenon]]
! colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Raynaud's Phenomenon]]<ref name="pmid11438158">{{cite journal |vauthors=Block JA, Sequeira W |title=Raynaud's phenomenon |journal=Lancet |volume=357 |issue=9273 |pages=2042–8 |date=June 2001 |pmid=11438158 |doi=10.1016/S0140-6736(00)05118-7 |url=}}</ref>
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
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| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
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|-
|-
! rowspan="2" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Venous insufficiency|Venous disorders]]
! rowspan="2" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Venous insufficiency|Venous disorders]]
! colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Superior vena cava obstruction]]
! colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Superior vena cava obstruction]]<ref name="pmid22477372">{{cite journal| author=Cohen R, Mena D, Carbajal-Mendoza R, Matos N, Karki N| title=Superior vena cava syndrome: A medical emergency? | journal=Int J Angiol | year= 2008 | volume= 17 | issue= 1 | pages= 43-6 | pmid=22477372 | doi= | pmc=2728369 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22477372  }}</ref>
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
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[[Facial]] [[swelling]]
[[Facial]] [[swelling]]
|-
|-
! colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Venous stasis]]
! colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Venous stasis]]<ref name="pmid21326688">{{cite journal| author=Fan CM| title=Venous pathophysiology. | journal=Semin Intervent Radiol | year= 2005 | volume= 22 | issue= 3 | pages= 157-61 | pmid=21326688 | doi=10.1055/s-2005-921949 | pmc=3036287 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21326688  }}</ref>
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
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|-
|-
! colspan="2" rowspan="2" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Hematologic diseases]]
! colspan="2" rowspan="2" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Hematologic diseases]]
! colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Methemoglobinemia]]
! colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Methemoglobinemia]]<ref name="pmid21954509">{{cite journal |vauthors=Ashurst J, Wasson M |title=Methemoglobinemia: a systematic review of the pathophysiology, detection, and treatment |journal=Del Med J |volume=83 |issue=7 |pages=203–8 |date=July 2011 |pmid=21954509 |doi= |url=}}</ref>
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
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| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Headache]], [[Altered mental status]], [[Delirium]], [[Seizure]], [[Coma]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Headache]], [[Altered mental status]], [[Delirium]], [[Seizure]], [[Coma]]
|-
|-
! colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Polycythemia]]
! colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Polycythemia]]<ref name="pmid11841424">{{cite journal |vauthors=Spivak JL |title=The optimal management of polycythaemia vera |journal=Br. J. Haematol. |volume=116 |issue=2 |pages=243–54 |date=February 2002 |pmid=11841424 |doi= |url=}}</ref>
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
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|-
|-
! colspan="2" rowspan="4" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Neurological disease]]
! colspan="2" rowspan="4" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Neurological disease]]
! style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Breath-holding spells]]
! style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Breath-holding spells]]<ref name="pmid25676645">{{cite journal| author=Goldman RD| title=Breath-holding spells in infants. | journal=Can Fam Physician | year= 2015 | volume= 61 | issue= 2 | pages= 149-50 | pmid=25676645 | doi= | pmc=4325862 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25676645  }}</ref>
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
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| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Fainting]], [[Twitching|Twitching muscles]], [[Seizure]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Fainting]], [[Twitching|Twitching muscles]], [[Seizure]]
|-
|-
! colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Seizure]]
! colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Seizure]]<ref name="pmid20689626">{{cite journal| author=Goldenberg MM| title=Overview of drugs used for epilepsy and seizures: etiology, diagnosis, and treatment. | journal=P T | year= 2010 | volume= 35 | issue= 7 | pages= 392-415 | pmid=20689626 | doi= | pmc=2912003 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20689626  }}</ref>
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
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| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Fainting]], [[Tonic-clonic|Tonic-clonic movements]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Fainting]], [[Tonic-clonic|Tonic-clonic movements]]
|-
|-
! colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Coma]]
! colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Coma]]<ref name="pmid21190458">{{cite journal| author=Brown EN, Lydic R, Schiff ND| title=General anesthesia, sleep, and coma. | journal=N Engl J Med | year= 2010 | volume= 363 | issue= 27 | pages= 2638-50 | pmid=21190458 | doi=10.1056/NEJMra0808281 | pmc=3162622 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21190458  }}</ref>
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
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| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Depressed [[brainstem]] reflexes, [[Agonal breathing]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Depressed [[brainstem]] reflexes, [[Agonal breathing]]
|-
|-
! colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Head trauma]]
! colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Head trauma]]<ref name="pmid22033563">{{cite journal| author=McAllister TW| title=Neurobiological consequences of traumatic brain injury. | journal=Dialogues Clin Neurosci | year= 2011 | volume= 13 | issue= 3 | pages= 287-300 | pmid=22033563 | doi= | pmc=3182015 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22033563  }}</ref>
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
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|-
|-
! colspan="2" rowspan="4" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Miscellaneous
! colspan="2" rowspan="4" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Miscellaneous
! colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[High altitude exposure]]
! colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[High altitude exposure]]<ref name="pmid29340578">{{cite journal |vauthors=Parati G, Agostoni P, Basnyat B, Bilo G, Brugger H, Coca A, Festi L, Giardini G, Lironcurti A, Luks AM, Maggiorini M, Modesti PA, Swenson ER, Williams B, Bärtsch P, Torlasco C |title=Clinical recommendations for high altitude exposure of individuals with pre-existing cardiovascular conditions |journal=Eur. Heart J. |volume= |issue= |pages= |date=January 2018 |pmid=29340578 |doi=10.1093/eurheartj/ehx720 |url=}}</ref>
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +/-
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +/-
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
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| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Dizziness]], [[Coma]],  Death
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Dizziness]], [[Coma]],  Death
|-
|-
! style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Septic shock]]
! style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Septic shock]]<ref name="pmid28117397">{{cite journal| author=Hotchkiss RS, Moldawer LL, Opal SM, Reinhart K, Turnbull IR, Vincent JL| title=Sepsis and septic shock. | journal=Nat Rev Dis Primers | year= 2016 | volume= 2 | issue=  | pages= 16045 | pmid=28117397 | doi=10.1038/nrdp.2016.45 | pmc=5538252 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28117397  }}</ref>
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| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Chills]], [[Hypothermia]], [[Loss of consciousness]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Chills]], [[Hypothermia]], [[Loss of consciousness]]
|-
|-
! style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Smoke inhalation]]
! style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Smoke inhalation]]<ref name="pmid20161170">{{cite journal| author=Rehberg S, Maybauer MO, Enkhbaatar P, Maybauer DM, Yamamoto Y, Traber DL| title=Pathophysiology, management and treatment of smoke inhalation injury. | journal=Expert Rev Respir Med | year= 2009 | volume= 3 | issue= 3 | pages= 283-297 | pmid=20161170 | doi=10.1586/ERS.09.21 | pmc=2722076 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20161170  }}</ref>
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +/-
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +/-
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
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| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Cough]], [[Hoarseness]], [[Hemoptysis]], [[Headache]], [[Fainting]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Cough]], [[Hoarseness]], [[Hemoptysis]], [[Headache]], [[Fainting]]
|-
|-
! style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Cold exposure]]
! style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Cold exposure]]<ref>{{cite book | last = Marriott | first = Bernadette | title = Nutritional needs in cold and in high-altitude environments : applications for military personnel in field operations | publisher = National Academy Press | location = Washington, D.C | year = 1996 | isbn = 0-309-05484-2 }}</ref>
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Revision as of 17:23, 14 April 2020

Congenital cyanotic heart disease Microchapters

Overview

Classification

Tetralogy of Fallot
Total anomalous pulmonary venous connection
Transposition of the great arteries
Truncus arteriosus
Ebstein's anomaly

Differential Diagnosis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Fahimeh Shojaei, M.D. Eiman Ghaffarpasand, M.D. [2]

Overview

Classification

Causes

Differential diagnosis

Congenital cyanotic heart disease should be differentiated from other conditions that causes cyanosis:

Diseases Cyanosis Clinical manifestations Para-clinical findings Gold standard Additional findings
Symptoms Physical examination
Lab Findings Imaging
Peripheral Central Dyspnea Fever Chest pain Clubbing Peripheral edema Auscultation CBC ABG Electrolytes Other X-ray CT scan Other
Pulmonary diseases Airway disorder Severe croup[1] + - + +/- - - - Stridor Lymphocytosis Normal Normal - Steeple sign Normal Distended hypopharynx during inspiration Clinical findings Intercostal and subcostal retraction, Barking cough
Epiglottitis[2] + - + + - - - Stridor Leukocytosis with neutrophilia Normal Normal - Thumb sign Normal - Laryngoscopy Muffled voice, Drooling
Foreign body aspiration[3] + - + - +/- - - Decreased breath sounds, Wheezing Normal Normal Normal - Hyperinflation, Atelectasis, Objects Foreign body entrapment with edema or granulation tissue - Bronchoscopy Mediastinitis
Bacterial tracheitis[4] + - + + + - - Inspiratory stridor Leukocytosis Normal Normal Blood culture, Gram stain Irregular tracheal margin Normal Steeple sign (confusing) Laryngotracheobronchoscopy Brassy cough, Hoarseness
Sleep apnea[5] - + + - - - - Normal Polycythemia O2, ↑CO2 Normal - Normal Normal Polysomnography Polysomnography Nightmares, Snoring
Chronic bronchitis[6] - + + +/- +/- + - Rales, crackles, Wheeze Leukocytosis O2, ↑CO2, Respiratory acidosis Hypokalemia, Hypernatremia Gram stain of sputum Elongated heart, Flattened diaphragms, Prominent hilar vasculature Bronchial wall thickening with increased bronchovascular markings - HRCT Productive cough, Chest tightness
Atelectasis[7] - + + - + - - Localized diminished breath sounds, Wheeze Leukocytosis O2, ↑CO2, Respiratory acidosis Normal - Localized increased opacity, Deviation toward the atelectasis Local crowding of pulmonary vessels and bronchi MRI for distinguishing obstructive from non-obstructive HRCT Cough, Shallow breathing
Parenchymal disorder Alveolitis[8] +/- + + + + +/- - Wheeze, Crackles Leukocytosis, Eosinophilia O2, ↑CO2 Normal ESR, ↑CRP Scattered opacities, Fine reticulation Homogeneous ground-glass opacity - HRCT PLUS Clinical findings Malaise, Chills, Headache
Pneumonia[9] - + + + + +/- - Rales, Crackles, Wheeze, Pleural friction rub Leukocytosis with neutrophilia Normal Hyponatremia - Entire lobe consolidated, Air bronchograms Focal ground-glass opacity - HRCT Tachycardia, Bradycardia (Legionella)
Asthma (Late)[10] - + + - +/- +/- - End expiratory wheeze Eosinophilia O2, ↑CO2 Normal IgE Atelectasis Allergic bronchopulmonary aspergillosis, Bronchiectasis - Spirometry before and after bronchodilator Triad of asthma, nasal polyps, and rash is indicative of aspirin sensitivity.
Cystic fibrosis[11] + - +/- +/- + - Wheeze, Crackles Normal O2, ↑CO2 Increased sweat chloride Sweat chloride test Hyperinflation, Nodules Peribronchial thickening, Bronchiectasis - Sweat chloride test Absent vas deferens
COPD

(Severe emphysema)[12]

+ - + +/- + +/- +/- Reduced breath sounds, Wheeze, Inspiratory crackles Polycythemia O2, ↑CO2 Normal Alpha 1-antitrypsin test Elongated heart, Flattened diaphragms, Prominent hilar vasculature Bullae - HRCT Pulmonary hypertension, Right heart failure
Tuberculosis[13] - + + + + +/- - Reduced breath sounds, Wheeze, Inspiratory crackles Leukocytosis, ↑Lymphocyte O2, ↑CO2 Hyponatremia, Hyperkalemia, Hypochloremia PPD, interferon-gamma release assay (IGRA) Dense, homogeneous parenchymal consolidation Nodules with low-density centers and rim enhancement Fluorodeoxyglucose positron emission tomography/CT (FDG PET/CT) Sputum culture, QuantiFERON-TB Gold (QFT) Loss of appetite, Night sweats
Pulmonary fibrosis[14] - + + - + + - Inspiratory crackles Anemia O2, ↑CO2 Normal Matrix metalloproteinases (MMPs) Honeycombing Traction bronchiectasis,

Interlobular septal thickening

HRCT HRCT Fatigue, Weight loss
Pneumoconiosis[15] - + + - +/- +/- - End expiratory wheeze Leukocytosis, Anemia O2, ↑CO2, Respiratory acidosis Hyper/Hypocalcemia,

Hypermagnesemia

- Small to large round nodular opacities Diffuse distribution of small nodules MRI and PET-CT scan CT/HRCT scan Tightness in the chest
Lung cancer[16] - + + - +/- + - Absence of breath sounds, Stridor, Wheezing Leukocytosis, Anemia O2, ↑CO2 Hyponatremia CRP, ↑ESR Pulmonary nodule or mass,

Mediastinal widening

Hilar lymphadenopathy

Massive lymphadenopathy, Direct mediastinal invasion MRI, PET-CT scan, Bronchoscopy Low dose computed tomography scan (LDCT) Weight loss, Loss of appetite
Acute respiratory distress syndrome[17] - + + +/- + - - Inspiratory crackles Leukopenia/Leukocytosis O2, ↓CO2, Respiratory alkalosis Hyponatremia, Hyperkalemia BNP, ↑Von Willebrand factor (VWF) Bilateral pulmonary infiltrates (patchy to diffuse) Emphysema, Pneumothorax and pneumomediastinum, Mediastinal lymphadenopathy Invasive Hemodynamic Monitoring (PCWP), Bronchoscopy Chest CT scan Tachypnea, Muscle weakness
Pulmonary vascular disorders Massive pulmonary embolism[18] + - + +/- + - +/- Reduced breath sounds, Crackles, Loud P2 Leukocytosis O2, ↑CO2, Respiratory acidosis Normal D-dimer, BNP Fleischner sign, Hampton hump, Westermark sign, Pleural effusion Filling defects in the pulmonary vasculature Spiral CT pulmonary angiogram Spiral CT pulmonary angiogram Tachycardia, Shock, Pulmonary hypertension
Pulmonary arterio-venous malformation[19][20][21] - + + - + + - Pulmonary bruit Normal O2, ↑CO2, Respiratory acidosis Normal - One or more rounded or multilobular opacities Connecting vessel in hilum Magnetic resonance angiography, Echocardiography Contrast enhanced magnetic resonance angiography Cerebral arteriovenous malformation
Pulmonary hypertension[22] - + + - +/- +/- - Tricuspid regurgitation murmur, Pulmonic insufficiency murmur Mild anemia O2, ↑CO2 Hypernatremia BNP, ↑ANP Right deviated cardiac apex,

Prominent pulmonary artery

Ill-defined nodules, Interlobular septal thickening CT pulmonary angiography (CTPA), MRA Cardiac catheterization (PCWP) Fatigue, Inability to exercise
Chest wall disorders Flail chest[23] + - + - + - - Normal Normal O2, ↑CO2 Normal - ≥3 adjacent ribs with segmental fractures, >5 adjacent rib fractures Normal - CXR Bruises over chest
Pneumothorax[24] + - + - + - - Diminished breath sounds Normal O2, ↑CO2 Normal - No lung marking on one side, Collapsed lung Loculated air in thoracic cavity M-mode ultrasonography Chest CT scan Tachypnea
Disease Peripheral Central Dyspnea Fever Chest pain Clubbing Peripheral edema Auscultation CBC ABG Electrolytes Other X-ray CT scan Other Gold standard Additional findings
Cardiac diseases Congenital disorders Atrioventricular canal defect[25] +/- + + - +/- +/- - Wheezing,Holosystolic or systolic ejection murmur Normal Normal Normal Pulse oximetry Cardiomegaly, Increased pulmonary vascular markings Normal Echocardiography, MRI Echocardiography Tachypnea, Lack of appetite, Pale skin color, Excessive sweating
Ebstein anomaly[26] - + +/- - +/- - - Loud S1 Normal Normal Normal Pulse oximetry Cardiomegaly, "Box shape" heart Apical displacement of the septal and posterior leaflets of the tricuspid valve "Atrialisation" of the right ventricle in MRI, Tricuspid regurgitation in echocardiography Echocardiography Fatigue, Palpitations
Tetralogy of Fallot[27] - + +/- - +/- - - Harsh systolic murmur Normal Normal Normal Pulse oximetry "Boot-shaped" heart with an upturned cardiac apex Aortopulmonary collateral vessels Peripheral pulmonary stenosis and atresia in echocardiography Echocardiography Fainting, Palpitation
Pulmonic stenosis[28] - + + - + +/- - Crescendo-decrescendo ejection murmur Schistocyte O2 Normal Pulse oximetry Right ventricular hypertrophy, Dilated main pulmonary artery Stenotic segment, Post stenotic dilatation Severity of the stenosis by velocity encoded phase contrast (VEC) cine sequences Echocardiography Fainting, Palpitation
Total anomalous pulmonary venous connection[29] - + + - +/- +/- - Systolic murmur over the pulmonary area Normal O2 Normal Pulse oximetry Snowman sign Anomalous venous return Blind ended left atrium with no connecting veins in echocardiography Echocardiography Pounding heart, Weak pulse, Extreme sleepiness
Transposition of the great vessels[30] - + + - +/- +/- - Diastolic and Systolic murmur Normal O2 Normal Pulse oximetry Cardiomegaly with narrow superior mediastinum (egg on a string sign) Abnormal great vessel anatomy Flow dynamics on Steady-state free precession (SSFP) MRI Echocardiography Lack of appetite, Poor weight gain
Truncus arteriosus[31] - + +/- - +/- +/- - Holosystolic or ejection type murmur Normal O2 Normal Pulse oximetry Moderate cardiomegaly, pulmonary plethora, Widened mediastinum Single cardiac trunk Anomalous anatomy in MRI Echocardiography Fatigue, Sweating, Pale or cool skin
Patent ductus arteriosus[32] - + +/- - +/- +/- - Continuous machinery murmur Normal O2, ↑CO2 Normal Pulse oximetry Cardiomegaly, Aortopulmonary window obsecuration Tortuous morphology of ductus (Krichenko classification) Spiral CT pulmonary angiogram Echocardiography Failure to thrive, Respiratory distress
Acquired disorders Heart failure[33] + - + +/- + - + Coarse crackles, S3 Anemia O2, ↑CO2 Hyponatremia, Hypokalemia, Hypomagnesemia Elevated BNP Pleural effusion, Cardiomegaly Kerley B lines Normal Radioisotope scan Echocardiography Generalized edema, Hepatomegaly
Valvular heart disease[34] + - + - - - + Murmurs Schistocyte Normal Normal Hyperthyroidism Valve calcification Normal Valvular dysfunction in echocardiography Echocardiography Syncope, Palpitation
Myocardial infarction[35] - + + +/- + - - S3 and S4 Normal Normal Hyponatremia, Hypokalemia Elevated troponin I and CKMB Rolling out other causes Coronary luminal narrowing in CT perfusion scan Wall motion abnormality in echocardiography Cardiac troponin I Dizziness, Fatigue, Lightheadedness, Cold sweat
Cardiogenic shock[36] +/- + + - - - + Muffled heart sound Anemia O2, ↑CO2 Hyperkalemia PaO2 in pulse oximetry Normal Normal Echocardiography Clinical findings Tachypnea, Palpitation, Hypotension, Weak pulse
Cardiomyopathy[37] - + + - + + + S3 and S4 Lymphocytosis O2, ↑CO2 Normal PaO2 in pulse oximetry Enlarged left ventricle and atria, Pulmonary edema Normal MRI Endomyocardial biopsy Arrhythmia, Bloating
Heart tumors[38] - + + - +/- +/- +/- Early diastolic tumor plop Normal Normal Normal Mild ↓PaO2 in pulse oximetry Calcification in lateral view Intracardiac mass Echocardiography Histologic diagnosis (biopsy) Syncope, Weight loss
Mitral Stenosis[39] - + + - +/- +/- +/- Diastolic murmur Normal Normal Normal Mild ↓PaO2 in pulse oximetry Left atrial enlargement, Mitral annular calcification Secondary pulmonary hemosiderosis Velocity-encoded cine-magnetic resonance imaging (VEC-MRI) Echocardiography Dizziness, Hemoptysis
Vascular disease Arterial disorders Acrocyanosis[40] + - +/- - - + - Normal Anemia, Leukocytosis O2, ↑CO2 Hypercalcemia PaO2 in pulse oximetry Normal Normal - Clinical findings Brittle nails, Telangiectasia
Arterial embolism[41] + - + - + +/- - Normal Normal Normal Hyperkalemia PaO2 in pulse oximetry Normal Normal Transesophageal echocardiography (TEE) Clinical findings Headache, Decreased sensation
Raynaud's Phenomenon[42] + - - - - + - Normal Polycythemia O2 Normal Mild ↓PaO2 in pulse oximetry Normal Normal - Clinical findings Sensitivity to cold, Decreased sensation
Venous disorders Superior vena cava obstruction[43] + - +/- - +/- +/- + Normal Polycythemia O2 Normal PaO2 in pulse oximetry Superior mediastinal widening, Right hilar prominence Thrombosis, Mediastinal mass or lymphadenopathy, Associated lung mass - Chest CT scan Headache,

Facial swelling

Venous stasis[44] + - - - - +/- + Normal Polycythemia O2 Hypercalcemia Normal Normal Normal Color-flow duplex ultrasound Color-flow duplex ultrasound Leg swelling, Pain during walking,

Leg ulcers

Disease Peripheral Central Dyspnea Fever Chest pain Clubbing Peripheral edema Auscultation CBC ABG Electrolytes Other X-ray CT scan Other Gold standard Additional findings
Hematologic diseases Methemoglobinemia[45] - + + +/- + - - Wheezing Anemia, Methemoglobinemia Normal PaO2, ↑SaO2, "Saturation gap" Normal SaO2 in pulse oximetry Normal Normal Echocardiography for ruling out other causes Co-oximetry, ABG paired with pulse oximetry. Serum methemoglobin levels Headache, Altered mental status, Delirium, Seizure, Coma
Polycythemia[46] + + + +/- +/- + - Normal RBC, ↑WBC, ↑HGB, ↑Plt O2 Hyperkalemia Leukocyte alkaline phosphatase, ↑Ferritin, ↑Erythropoietin AVM, COPD, pulmonary hypertension Normal Abdominal ultrasound or renal vascular studies for ruling out renal artery stenosis RBC mass (RCM) and plasma volume measurement Itchiness, Headache. Dizziness. Blurred vision
Neurological disease Breath-holding spells[47] - + + - +/- - - Wheezing Hypochromic microcytic anemia O2 Hypocalcemia, Hypokalemia Iron deficiency Ruling out foreign body aspiration Normal EEG monitoring Clinical findings Fainting, Twitching muscles, Seizure
Seizure[48] - + + +/- - - - Normal Normal O2, ↑CO2 Hyponatremia, Hypo/Hypercalcemia CPK, ↑LDH, Normal Normal EEG EEG Fainting, Tonic-clonic movements
Coma[49] - + - - - - +/- Wheezing Normal O2, ↑CO2 Normal - Underlying disease Underlying disease - Glasgow Coma Scale (GCS) Depressed brainstem reflexes, Agonal breathing
Head trauma[50] - + + - - - - Normal Normal O2, ↑CO2 Normal - Skull fracture Intracranial hemorrhage MRI CT scan Nausea, Hypertension, Bradycardia,Tachypnea
Miscellaneous High altitude exposure[51] +/- + + - +/- + - Wheezing Polycythemia O2, ↓CO2, Respiratory alkalosis Hyperphosphatemia, Hypercalcemia, Hyponatremia, Hypokalemia, Hypomagnesemia Decreased bicarbonate Central interstitial edema Pulmonary consolidation - Hypoxic challenge test Dizziness, Coma, Death
Septic shock[52] + - + + +/- - - Rales, crackles, Wheeze, Pleural friction rub Leukocytosis with neutrophilia O2, ↑CO2, Metabolic acidosis Hyperkalemia ESR, ↑CRP Consolidation Pulmonary infiltration Echocardiography Blood culture Chills, Hypothermia, Loss of consciousness
Smoke inhalation[53] +/- + + - + - - Wheezing Anemia, Carboxyhemoglobin O2, ↑CO2, Respiratory acidosis Normal CO-oximetry Diffuse opacities Pulmonary infiltration Pulmonary function testing Bronchoscopy Cough, Hoarseness, Hemoptysis, Headache, Fainting
Cold exposure[54] + - +/- - - - - Normal Leukopenia, ↑RBC O2, ↑CO2, Metabolic acidosis Hypokalemia, Hypocalcemia Hyperglycemia, ↑CK Normal Normal - Clinical findings Confusion, Tachycardia/Bradycardia, Coma

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