Sandbox: Ifeoma: Difference between revisions

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* Transesophageal echocardiography (TEE)
* TEE
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* It is associated with migraine headache and decompression sickness in divers
* It is associated with migraine headache and decompression sickness in divers
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* Transthoracic echocardiography (TTE)
* TTE
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Revision as of 17:35, 19 February 2020

Diseases Clinical manifestations Para-clinical findings Gold standard Additional findings
Symptoms Physical examination
Imaging
Exertional dyspnea Failure to thrive Pulmonary hypertension Murmur on auscultation Vital signs Physical exam 3 Echocardiography Chest x-ray Cardiac CT
Patent foramen ovale
  • Appearance of at least 3 micro-bubbles in the left atrium within three cardiac cycles after the complete opacification of the right atrium
  • TEE
  • It is associated with migraine headache and decompression sickness in divers
Atrial septal defect +/− +/− +/−
  • Systolic flow murmur in the pulmonary valve region
  • Wide, fixed splitting of S2
  • Diastolic flow rumble across the tricuspid valve
  • TTE
Coarctation of the aorta
Diseases Symptom 1 Symptom 2 Symptom 3 Physical exam 1 Physical exam 2 Physical exam 3 Imaging 1 Imaging 2 Imaging 3 Gold standard Additional findings
Differential Diagnosis 4
Differential Diagnosis 5
Differential Diagnosis 6






Diseases Pathophysiology Shunt Symptoms Diagnosis Echocardiography findings Physical examination Treatment Complications
Patent foramen ovale
  • Failure of fusion of the septum primum and septum secundum leading to a flap valve opening.
  • Right-to-left shunt
  • More prominent with increased right atrial pressure.
  • Majority of patients are asymptomatic
  • TEE (Gold standard)
  • TTE
  • TCD
  • Appearance of at least 3 micro-bubbles in the left atrium within three cardiac cycles after the complete opacification of the right atrium
  • Percutaneous closure
  • Anticoagulants
  • Antiplatelets
  • Paradoxical embolism
  • Migraine with aura
  • Decompression sickness in divers
  • Platypnea-orthodeoxia syndrome
Atrial septal defect
  • Ostium secundum defect: Failure of the septum secundum to occlude the ostium secundum.
  • Ostium primum defect: Failure of the ostium primum to fuse with the endocardial cushions.
  • Superior sinus venosus defect: The orifice of the superior vena cava overrides the atrial septum above the fossa ovalis.
  • Inferior sinus venosus defect: The orifice of the inferior vena cava overrides the left and right atrium.
  • Coronary sinus defect: Absence of a portion of the common wall that separates the coronary sinus and the left atrium.
  • Continuous left-to-right shunt
  • Failure to thrive, tachypnea, recurrent respiratory infections, heart failure
  • Commonly asymptomatic during childhood and adolescence
  • Adults with large shunts may become symptomatic in the fourth decade presenting with fatigue, exercise intolerance, palpitations, syncope, and shortness of breath.
  • TTE (Gold standard)
  • Cardiac CT
  • Cardiac MRI
  • Hypermobile interatrial septum
  • Abrupt septal irregularity
  • Right atrial and ventricular volume overload
  • Pulmonary artery dilation
  • Coronary sinus defect: Enlarged ostium of the coronary sinus and unroofing of the terminal portion of the coronary sinus
  • Systolic flow murmur in the pulmonary valve region
  • Wide, fixed splitting of S2
  • Diastolic flow rumble across the tricuspid valve
  • Right ventricular heave
  • Spontaneous closure
  • Percutaneous transcatheter closure
  • Surgical closure
  • Right sided heart failure
  • Peripheral edema
  • Eisenmenger syndrome (cyanosis)
  • Paradoxical emboli
  • Pulmonary hypertension
Pulmonary ateriovenous fistula
  • Abnormal blood vessel(s) connecting the pulmonary arteries and veins directly without interposition of pulmonary capillaries
  • Right-to-left shunt between the pulmonary artery and pulmonary vein
  • Symptoms may occur only after the second decade
  • Cyanosis
  • Hemoptysis
  • Chest CT
  • Pulmonary arteriogram
  • Appearance of contrast bubbles in the left atrium three to five cardiac cycles after appearance in the right atrium
  • Clubbing
  • Systolic/continuous murmur
  • Embolization
  • Surgical resection
  • Cerebral ischemia/abscess
  • Hemothorax















  • Patent foramen ovale may be classified anatomically according to the shape of the tunnel using a real time 3-dimensional transesophageal echocardiography (RT3D-TEE). It is classified based on the minimum overlap of the septum primum and septum secundum under valsalva maneuver.
  • The table below shows the different tunnel types:
Patent Foramen Ovale Tunnel Type Description
Type 1
  • Complete overlap
Type 2
  • Partial overlap (≧ 4 mm)
Type 3
  • Little or zero overlap (< 3 mm)
Diseases Anatomy Shunt Symptoms Physical Education Diagnosis Treatment Complications
Type 1
  • Complete overlap
Type 2
  • Partial overlap (≧ 4 mm)
Type 3
  • Little or zero overlap (< 3 mm)