Mitral regurgitation differential diagnosis: Difference between revisions

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{{CMG}}; '''Associate Editor-In-Chief:''' {{CZ}}; [[Varun Kumar]], M.B.B.S.; [[Lakshmi Gopalakrishnan]], M.B.B.S.; [[User:Mohammed Sbeih|Mohammed A. Sbeih, M.D.]] [mailto:msbeih@perfuse.org]
{{CMG}}; '''Associate Editor-In-Chief:''' {{CZ}}; [[Varun Kumar]], M.B.B.S.; [[Lakshmi Gopalakrishnan]], M.B.B.S.; [[User:Mohammed Sbeih|Mohammed A. Sbeih, M.D.]] [mailto:msbeih@perfuse.org]


==Differential Diagnosis of Mitral Regurgitaion==
==Differentiating Mitral Regurgitation from Tricuspid Regurgitation and Ventricular Septal Defects==
All the three cardiac conditions have holosystolic murmur on auscultation. But they can be differentiated by characteristics of the murmur detailed below:


In alphabetical order:
{|border="1px" bgcolor="CadetBlue"
 
|-align="center"
*Atrial septal defect (Ostium primum).
|'''Mitral Regurgitation'''
* [[Amyloid]] <ref>British Medical Journal case reports; doi:10.1136/bcr.08.2008.0821</ref>.
|'''Tricuspid Regurgitation'''
*[[Ankylosing spondylitis]].
|'''VSD'''
*[[Aortic insufficiency]].
|-bgcolor="PaleTurquoise" valign="top"
* [[Cardiomyopathy]].
|
*Cohen syndrome.
*The murmur in mitral regurgitation is high pitched and best heard at the apex with diaphragm of the stethoscope with patient in the lateral decubitus position.  
*[[Collagen vascular disease]]s.
*Left ventricular function can be assessed by determining the apical impulse.  
*Contractural [[arachnodactyly]].
*A normal or hyperdynamic apical impulse suggests good ejection fraction and primary mitral regurgitation.  
* [[Coronary Heart Disease]].
*A displaced and sustained apical impulse suggests decreased ejection fraction and chronic and severe mitral regurgitation.
* Congenital [[mitral regurgitation]].
|
*[[Dilated cardiomyopathy]].
*Can be best heard over the fourth intercostal area at left sternal border.
* [[Ehlers-Danlos Syndrome]].
*The intensity can be accentuated following inspiration ([[Carvallo's sign]]) due to increased regurgitant flow in right ventricular volume.
*[[Endocardial cushion defect]].
*Tricuspid regurgitation is most often secondary to [[pulmonary hypertension]].
*Endomyocardial fibrosis.
*Primary tricuspid regurgitation is less common and can be due to bacterial endocarditis following IV drug use, [[Ebstein's anomaly]], [[carcinoid disease]], or prior [[right ventricular infarction]].
*[[Fabry disease]].
|
*Familial hypertrophic [[cardiomyopathy]].
*The holosystolic murmur can be best heard over the left third and fourth intercostal spaces and along the sternal border.
* [[Heart Failure]].
*When the shunt becomes reversed ("[[Eisenmenger's syndrome]]"), the murmur may be absent and S<sub>2</sub> can become markedly accentuated and single.
*Heart tumors.
|}
*High blood pressure.
* [[Hypertrophic obstructive cardiomyopathy]].
* Infective [[endocarditis]] <ref name=agabegi2nd-ch1>{{cite book|author=Elizabeth D Agabegi; Agabegi, Steven S. |title=Step-Up to Medicine (Step-Up Series) |publisher=Lippincott Williams & Wilkins |location=Hagerstwon, MD |year=2008 |pages=|isbn=0-7817-7153-6 |oclc= |doi= |accessdate=}}  Chapter 1: Diseases of the Cardiovascular system > Section: Valvular Heart Disease</ref>.
* Left ventricular dilation.
* [[Marfan Syndrome]].
* Mitral annular calcification.
* [[Mitral valve prolapse]].
* [[Myocardial Infarction]].
* [[Myocardial ischemia]].
* Myxomatous degeneration.
* [[Osteogenesis imperfecta]].
*[[Papillary muscle rupture]] <ref name=agabegi2nd-ch1/>.
*Polychondritis.
*Polycystic kidney disease-adult (autosomal dominant type).
* [[Prosthetic valve]] dysfunction.
*Pseudoxanthoma elasticum.
* [[Rheumatic Heart Disease]].
*[[Rheumatoid arthritis]].
* [[Syphilis]] if left untreated.
* [[Systemic Lupus Erythematosus]].
*[[Takotsubo cardiomyopathy]].
* [[Trauma]].
*[[Turner syndrome]].
*[[X-linked]] inherited conditions such as [[fabry disease]].


==References==
==References==

Revision as of 15:38, 6 April 2012

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]; Varun Kumar, M.B.B.S.; Lakshmi Gopalakrishnan, M.B.B.S.; Mohammed A. Sbeih, M.D. [3]

Differentiating Mitral Regurgitation from Tricuspid Regurgitation and Ventricular Septal Defects

All the three cardiac conditions have holosystolic murmur on auscultation. But they can be differentiated by characteristics of the murmur detailed below:

Mitral Regurgitation Tricuspid Regurgitation VSD
  • The murmur in mitral regurgitation is high pitched and best heard at the apex with diaphragm of the stethoscope with patient in the lateral decubitus position.
  • Left ventricular function can be assessed by determining the apical impulse.
  • A normal or hyperdynamic apical impulse suggests good ejection fraction and primary mitral regurgitation.
  • A displaced and sustained apical impulse suggests decreased ejection fraction and chronic and severe mitral regurgitation.
  • The holosystolic murmur can be best heard over the left third and fourth intercostal spaces and along the sternal border.
  • When the shunt becomes reversed ("Eisenmenger's syndrome"), the murmur may be absent and S2 can become markedly accentuated and single.

References

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