Sandbox: Ifeoma: Difference between revisions
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Wikidoc practice session | |||
{{cquote|I can't wait for covid to be over!}} | |||
{{SK}} | |||
==Classification of dextrocardia== | |||
{| style="border: 0px; font-size: 90%; margin: 3px; width: 1000px" | |||
|valign=top| | |||
|+ | |||
! style="background: #4479BA; width: 250px; color: #FFFFFF;"|'''Dextrocardia Types''' | |||
! style="background: #4479BA; width: 600px; color: #FFFFFF;"|'''Description''' | |||
|- | |||
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align=center | '''Dextrocardia with situs solitus '''|| style="padding: 5px 5px; background: #F5F5F5;" | | |||
:* 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). | |||
:* 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. | |||
|- | |||
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align=center | '''Dextrocardia with situs inversus '''|| style="padding: 5px 5px; background: #F5F5F5;"| | |||
:* 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). | |||
|- | |||
| 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;"| | |||
:* Dextrocardia with any of the above relationships between the ventricles and great vessels. | |||
|- | |||
{| | {| | ||
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! style="background: #4479BA; color: #FFFFFF; text-align: center;|Exertional dyspnea | ! style="background: #4479BA; color: #FFFFFF; text-align: center;|Exertional dyspnea | ||
! colspan="1" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;|Failure to thrive | ! colspan="1" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;|Failure to thrive | ||
! style="background: #4479BA; color: #FFFFFF; text-align: center;| | ! style="background: #4479BA; color: #FFFFFF; text-align: center;|Recurrent respiratory infections | ||
! style="background: #4479BA; color: #FFFFFF; text-align: center;|Murmur on auscultation | ! style="background: #4479BA; color: #FFFFFF; text-align: center;|Murmur on auscultation | ||
! colspan="1" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;| | ! colspan="1" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;|Peripheral edema | ||
! style="background: #4479BA; color: #FFFFFF; text-align: center;| | ! style="background: #4479BA; color: #FFFFFF; text-align: center;|Clubbing | ||
! style="background: #4479BA; color: #FFFFFF; text-align: center;|Echocardiography | ! style="background: #4479BA; color: #FFFFFF; text-align: center;|Echocardiography | ||
! style="background: #4479BA; color: #FFFFFF; text-align: center;|Chest x-ray | ! style="background: #4479BA; color: #FFFFFF; text-align: center;|Chest x-ray | ||
! style="background: #4479BA; color: #FFFFFF; text-align: center;|Cardiac CT | ! style="background: #4479BA; color: #FFFFFF; text-align: center;|Cardiac CT | ||
|- | |- | ||
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Patent foramen ovale | | style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Patent foramen ovale]] | ||
| style="background: #F5F5F5; padding: 5px; text-align: center;" | − | | style="background: #F5F5F5; padding: 5px; text-align: center;" | − | ||
| style="background: #F5F5F5; padding: 5px; text-align: center;" | − | | style="background: #F5F5F5; padding: 5px; text-align: center;" | − | ||
Line 31: | Line 75: | ||
| style="background: #F5F5F5; padding: 5px; text-align: center;" | − | | style="background: #F5F5F5; padding: 5px; text-align: center;" | − | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* Appearance of at least 3 micro-bubbles in the left atrium within three cardiac cycles after | * Appearance of at least 3 micro-bubbles in the left atrium within three cardiac cycles after complete opacification of the right atrium | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px; text-align: center;" | Non specific | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px; text-align: center;" | | ||
* 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 | |||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* | * Echocardiogram | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* It is associated with paradoxical embolism, migraine headache, and decompression sickness in divers | |||
|- | |- | ||
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Atrial septal defect | | style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Atrial septal defect]] | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px; text-align: center;" | +/− | ||
| style="background: #F5F5F5; padding: 5px; | | style="background: #F5F5F5; padding: 5px; text-align: center;" | +/− | ||
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/− | |||
| style="background: #F5F5F5; padding: 5px; | |||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* Systolic flow murmur in the upper left sternal border | |||
* Wide, fixed splitting of S2 | |||
* Diastolic flow rumble across the tricuspid valve | |||
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/− | |||
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/− | |||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* Hypermobile interatrial septum | |||
* Abrupt septal irregularity | |||
* Right atrial and ventricular volume overload | |||
* Pulmonary artery dilatation | |||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* Cardiomegaly | |||
* Pulmonary artery enlargement/increased pulmonary vascularity | |||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* Enlargement of the right atrium and ventricle | |||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* | * Echocardiogram | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* 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 | |||
|- | |- | ||
| style="background: #DCDCDC; padding: 5px; text-align: center;" | | | style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Ventricular septal defect]] | ||
| style="background: #F5F5F5; padding: 5px;" |-/+ | |||
| style="background: #F5F5F5; padding: 5px;" |-/+ | |||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" |After Eisenmenger syndrome | ||
| style="background: #F5F5F5; padding: 5px;" | | |||
| style="background: #F5F5F5; padding: 5px;" | | |||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* Holosystolic murmur | |||
* May mimic aortic stenosis(mid/end dyastolic murmur due to increased pulmonary circulation) | |||
| style="background: #F5F5F5; padding: 5px;" |-/+ | |||
| style="background: #F5F5F5; padding: 5px;" |-/+ | |||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* Defect localization | |||
*septal dropout in the area adjacent to the tricuspid septal leaflet and below the right border of the aortic annulus | |||
* Direction of jet | |||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* [[Cardiomegaly]] in large VSD | |||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* Direct visualisation of murmur | |||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* Echocardiogram | |||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
|- style="background: #4479BA; color: #FFFFFF; text-align: center;" | |- style="background: #4479BA; color: #FFFFFF; text-align: center;" | ||
!Diseases | !Diseases | ||
! | !Exertional dyspnea | ||
! colspan="1" rowspan="1" | | ! colspan="1" rowspan="1" |Failure to thrive | ||
! | !Recurrent respiratory infections | ||
! | !Murmur on auscultation | ||
! colspan="1" rowspan="1" | | ! colspan="1" rowspan="1" |Peripheral edema | ||
! | !Clubbing | ||
! | !Echocardiography | ||
! | !Chest x-ray | ||
! | !Cardiac CT | ||
|'''Gold standard''' | |'''Gold standard''' | ||
!Additional findings | !Additional findings | ||
|- | |- | ||
| style="background: #DCDCDC; padding: 5px; text-align: center;" | | | style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Patent ductus arteriosus]] | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* Not at beginning | |||
* May be produced during the course of disease | |||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* Depends on the size | |||
| style="background: #F5F5F5; padding: 5px;" | - | |||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* Continuous machine-like murmur | |||
| style="background: #F5F5F5; padding: 5px;" |- | |||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* May be present by progressing | |||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* Golden standard | |||
* In color-Doppler visualization of flow through the patent duct which has a high velocity | |||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* Non-specific | |||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* Used for determining Krichenko classification | |||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* Echocardiogram | |||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* Krichenko criteria for classification is a very important factor for treatment | |||
|- | |- | ||
| style="background: #DCDCDC; padding: 5px; text-align: center;" | | | style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Aortic coarctation|Coarctation of the aorta]] | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px; text-align: center;" | +/− | ||
| style="background: #F5F5F5; padding: 5px; | | style="background: #F5F5F5; padding: 5px; text-align: center;" | +/− | ||
| style="background: #F5F5F5; padding: 5px; text-align: center;" | − | |||
| style="background: #F5F5F5; padding: 5px; | |||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* Systolic murmur over the upper sternal border with radiation to the back | |||
*Murmur of mitral regurgitation (holosystolic murmur best heard at the apex) | |||
| style="background: #F5F5F5; padding: 5px; text-align: center;" | − | |||
| style="background: #F5F5F5; padding: 5px; text-align: center;" | − | |||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* Narrowing of the aortic arch at the level of the isthmus | |||
* Left ventricular hypertrophy | |||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* Notching of the posterior fourth to eighth ribs due to dilated intercostal arteries | |||
* Indentation of the aorta at the site of coarctation with pre- and post-stenotic dilation of the aorta (classic "3 sign") | |||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* Dilation of the intercostal arteries | |||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* Echocardiogram | |||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
*Patients present with arm-leg blood pressure gradient of >20mmHg | |||
|- | |- | ||
| style="background: #DCDCDC; padding: 5px; text-align: center;" | | | style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Aortic stenosis]] | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" |+ | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" |+ | ||
| style="background: #F5F5F5; padding: 5px;" |+ | |||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* Crescendo-decrescendo mid-systolic (or ejection systolic) murmur | |||
| style="background: #F5F5F5; padding: 5px;" |+/- | |||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* Depending on severity | |||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* Used for finding the location of stenosis | |||
* Finding severity | |||
* Evaluating the flow jet with color-Doppler ultrasound technique | |||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* Non-specific at the beginning | |||
* At progressed stage calcification of the valve and cardiomegally | |||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
*[[Aortic calcification|Calcification score]] | |||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* MRI | |||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* MRI provides a more detailed structural and dynamic assessment of the aortic valve and left ventricle, in particular | |||
|- | |||
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Pulmonary valve stenosis|Pulmonary stenosis]] | |||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* Depending on severity | |||
| style="background: #F5F5F5; padding: 5px;" | - | |||
| style="background: #F5F5F5; padding: 5px;" | -/+ | |||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* Continuous systolic murmur | |||
| style="background: #F5F5F5; padding: 5px;" |- | |||
| style="background: #F5F5F5; padding: 5px;" | -/+ | |||
| style="background: #F5F5F5; padding: 5px;" | | |||
* Right atrial hypertrophy | |||
| style="background: #F5F5F5; padding: 5px;" | | |||
* Non-specific | |||
| style="background: #F5F5F5; padding: 5px;" | | |||
* Direct visualization of stenosis | |||
| style="background: #F5F5F5; padding: 5px;" | | |||
* Echocardiogram | |||
| style="background: #F5F5F5; padding: 5px;" | | |||
|} | |} | ||
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|} | |} | ||
==Differential table for aortic stenosis== | |||
{| class="wikitable" | |||
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;|Diseases | |||
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;|History | |||
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;|Symptoms | |||
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;|Physical Examination | |||
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;|Murmur | |||
! colspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;|Diagnosis | |||
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;|Other Findings | |||
|- style="background: #DCDCDC; padding: 5px; text-align: center;" | |||
!style="background: #4479BA; color: #FFFFFF; text-align: center;|ECG | |||
!style="background: #4479BA; color: #FFFFFF; text-align: center;|CXR | |||
!style="background: #4479BA; color: #FFFFFF; text-align: center;|Echocardiogram | |||
!style="background: #4479BA; color: #FFFFFF; text-align: center;|Cardiac Catheterization | |||
|- | |||
|style="background: #DCDCDC; padding: 5px; text-align: center;" |Aortic stenosis | |||
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" | | |||
* Age (aortic valve calcification) | |||
*Syncope | |||
*Orthopnea | |||
*Paroxysmal nocturnal dyspnea | |||
*Acute rheumatic fever | |||
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" | | |||
* Chest pain | |||
*Dyspnea on exertion | |||
*Palpitations | |||
*Symptoms of heart failure | |||
| style="vertical-align: top;background: #F5F5F5; padding: 5px;" | | |||
* Pulsus parvus et tardus | |||
*Pulmonary rales | |||
*Peripheral edema (In CHF patients) | |||
*Jugular venous distension | |||
*Enlarged and laterally displaced point of maximal impulse | |||
* | |||
| style="vertical-align: top;background: #F5F5F5; padding: 5px;" | | |||
* Crescendo-decrescendo systolic murmur | |||
*Best heard at the right upper sternal border | |||
*Radiation to the carotid arteries | |||
*Increases with squatting | |||
*Decreases with valsalva maneuver | |||
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Left ventricular hypertrophy''': | |||
* Wide QRS complex (especially in leads V1-V6) | |||
*ST depression in leads V5-V6 | |||
*Left axis deviation | |||
* | |||
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" | | |||
* Enlarged left ventricle | |||
* Enlarged left atrium and pulmonary artery in severe cases | |||
*Calcification of the aortic valve | |||
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" | | |||
* Thickening and calcification of the aortic valve | |||
*Left ventricular hypertrophy | |||
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Left heart catheterization:''' | |||
* Left ventricular and aortic pressures | |||
*The left ventricle generates higher pressures than what is transmitted to the aorta | |||
| style="vertical-align: top;background: #F5F5F5; padding: 5px;" | | |||
* Associated with von Willibrand disease | |||
|- | |||
| colspan="10" | | |||
|- | |||
|style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Mitral Stenosis]] | |||
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" | | |||
* Age ( Mitral annular calcification in older patients) | |||
* [[Rheumatic fever]] | |||
* [[Endocarditis]] | |||
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" | | |||
* [[Dyspnea on exertion]] | |||
* [[Paroxysmal nocturnal dyspnea]] | |||
* [[Orthopnea]] | |||
* New onset [[atrial fibrillation]] | |||
| style="vertical-align: top;background: #F5F5F5; padding: 5px;" | | |||
* Mitral facies | |||
* Heart murmur | |||
* [[JVD|Jugular vein distension]] | |||
* Apical impulse displaced laterally or not palpable | |||
* Diastolic thrill at the apex | |||
* Signs of heart failure in severe cases | |||
| style="vertical-align: top;background: #F5F5F5; padding: 5px;" | | |||
* Diastolic murmur | |||
* Low pitched | |||
* Opening snap followed by decrescendo-crescendo rumbling murmur | |||
* Best heard with the bell of the stethoscope at apex at end-expiration in left lateral decubitus position | |||
* Intensity increases after a [[valsalva maneuver]], after exercise and after increased after load (eg., squatting, isometric hand grip) | |||
| style="vertical-align: top;background: #F5F5F5; padding: 5px;" | | |||
* [[P mitrale]] | |||
* [[Atrial fibrillation]]: No P waves and irregularly irregular rhythm | |||
* [[Right axis deviation]] | |||
* Right ventricular hypertropy: Dominant R wave in V1 and V2 | |||
| style="vertical-align: top;background: #F5F5F5; padding: 5px;" | | |||
* Straightening of the left border of the heart suggestive of enlargement of the [[left atrium]] | |||
* Double right heart border (Enlarged left atrium and normal right atrium) | |||
* Prominent left atrial appendage | |||
* Splaying of [[carina|subcarinal angle]] (>120 degrees) | |||
* Calcification of [[mitral valve]] | |||
* | * [[Kerley B lines]] | ||
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" | | |||
* Reduced valve leaflet mobility | |||
| | |||
* Valve calcification | |||
* Doming of mitral valve | |||
* Valve thickening | |||
* Enlargement of left atrium | |||
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Right heart catheterization:''' | |||
* [[Pulmonary capillary wedge pressure]] (left atrial pressure) | |||
'''Left heart catheterization:''' | |||
* Pressures in left ventricle | |||
* Determines the gradient between the left and right atrium during ventricular diastole (marker of the severity of mitral stenosis) | |||
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" | | |||
* [[Hemoptysis]] ([[heart failure]]) | |||
* [[Ortner's syndrome]] | |||
|- | |||
| colspan="10" | | |||
|- | |- | ||
|style="vertical-align: top;background: #DCDCDC; padding: 5px; text-align: center;" |[[Mitral Regurgitation]] | |||
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" | | |||
* [[CAD]] | |||
* [[MI]] | |||
* [[Rheumatic fever]] | |||
* [[Endocarditis]] | |||
* [[Mitral valve prolapse]] | |||
* [[Cardiomyopathy]] | |||
* [[Radiation therapy]] | |||
* Trauma | |||
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" | | |||
* [[Palpitations]] | |||
* Symptoms of heart failure in severe cases | |||
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Palpation''' | |||
* Brisk carotid upstroke and hyperdymanic carotid impulse on palpation | |||
* Apical impulse is displaced to left | |||
* S3 and a palpable thrill | |||
'''Auscultation''' | |||
* Murmur | |||
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" | | |||
* [[Holosystolic murmur]] | |||
* High pitched, blowing | |||
* Radiates to axilla | |||
* Best heard with the diaphragm of the stethoscope at apex in left lateral [[decubitus]] position | |||
* Intensity increases with hand grip or squatting | |||
* Decrease in intensity on standing or [[valsalva maneuver]] | |||
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" | | |||
* [[P mitrale]] in lead II | |||
* Increased QRS voltage | |||
* [[Right axis deviation]] | |||
* [[Atrial fibrillation]] | |||
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Acute MR''' | |||
* [[Kerley B lines]] | |||
* No enlargement of cardiac silhouette | |||
'''Chronic MR''' | |||
* Enlarged cardiac silhouette | |||
* Straightening of left heart border | |||
* Splaying of subcarinal angle | |||
* Calcification of mitral annulus | |||
* Double right heart border | |||
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" | | |||
* Enlargement of left atrium and ventricle | |||
* Identify valve abnormality | |||
* Valve calcification | |||
* Severity of regurgitation | |||
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" | | |||
* Grading of MR is done with left ventriculography | |||
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" | | |||
* Decompensated and acute MR may lead to [[heart failure]] | |||
|- | |||
| colspan="10" | | |||
|- | |- | ||
|style="vertical-align: top;background: #DCDCDC; padding: 5px; text-align: center;" |[[Atrial septal defect]] | |||
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" | | |||
* Frequent respiratory or lung infections | |||
* [[Dyspnea]] | |||
* Tiring when feeding (Infants) | |||
* Shortness of breath on exertion | |||
* [[Palpitations]] | |||
* Swelling of feet | |||
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" | | |||
* [[Shortness of breath]] | |||
* [[Fatigue]] | |||
* [[Failure to thrive]] | |||
* Swelling of feet and abdomen ([[Right heart failure]]) | |||
* [[Palpitations]] | |||
* Respiratory infections | |||
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Inspection''' | |||
* Precordial bulge | |||
* Precordial lift | |||
'''Palpation''' | |||
* Right ventricular impulse | |||
* Pulmonary artery pulsations | |||
* Thrill | |||
'''Auscultation''' | |||
* Murmur | |||
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" | | |||
* Midsystolic (ejection systolic) murmur | |||
* Widely split, fixed S2 | |||
* Upper left sternal border | |||
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" | | |||
* Normal | |||
* Prolonged PR interval | |||
* [[Right bundle branch block]] | |||
* ECG findings varies according to the underlying type of ASD | |||
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" | | |||
*Increased pulmonary markings | |||
*[[Cardiomegaly]] | |||
*Triangular appearance of heart | |||
*Schimitar sign | |||
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" | | |||
* Gold standard test for diagnosis of atrial septal defect (for more information click [[Atrial septal defect echocardiography]]) | |||
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" | | |||
* Defect size | |||
* Pulmonary venous return | |||
* [[Pulmonary vascular resistance]] | |||
* [[Pulmonary artery hypertension]] | |||
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" | | |||
* Asymptomatic until later part of their life | |||
* May be associated with [[migraine with aura]] | |||
|- | |- | ||
| colspan="10" | | |||
|- | |||
|style="vertical-align: top;background: #DCDCDC; padding: 5px; text-align: center;" |[[Atrial myxoma|Left Atrial Myxoma]] | |||
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" | | |||
* [[Dyspnea]] | |||
* [[Orthopnea]] | |||
* [[Pulmonary edema]] | |||
* Hyperpigmentation of skin and endocrine activity | |||
* Cerebral [[embolism]] | |||
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" | | |||
* Symptoms may mimic mitral stenosis | |||
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Skin''' | |||
* Signs of an embolic phenomenon | |||
* [[Raynaud's phenomenon]] | |||
* Swelling | |||
* Clubbing | |||
'''Auscultation:''' | |||
* Lung: Fine crepitations | |||
| style=" | * Heart: Characteristic "tumor plop" | ||
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" | | |||
* Early diastolic sound as "tumor plop" | |||
* Low frequency diastolic murmur may be heard if the tumor obstructing mitral valve | |||
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" | | |||
* Often normal | |||
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" | | |||
* Often normal | |||
'''Rare findings:''' | |||
* [[cardiomegaly]] | |||
* Left atrial enlargement | |||
* tumor calcification etc., | |||
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" | | |||
* Initial and most useful diagnostic study | |||
* For more information click [[Myxoma echocardiography or ultrasound]] | |||
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" | | |||
* Useful to detect vascular supply of the tumor by the coronary arteries | |||
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" | | |||
* Associated with Carney complex (genetic predisposition) | |||
|- | |- | ||
| colspan="10" | | |||
|- | |||
|style="vertical-align: top;background: #DCDCDC; padding: 5px; text-align: center;" |Prosthetic Valve Obstruction | |||
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" | | |||
* History of valve replacement | |||
* Systemic embolism | |||
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" | | |||
* Shortness of breath | |||
* Fatigue | |||
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Ausculation''' | |||
Muffling of murmur | |||
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" | | |||
* Muffling or disappearance of prosthetic sounds | |||
* Appearance of new regurgitant or obstructive murmur | |||
| style="background: #F5F5F5; padding: 5px; text-align: center;" | − | |||
| style="background: #F5F5F5; padding: 5px; text-align: center;" | − | |||
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" | | |||
* Degree of stenosis | |||
* Assess thrombus size and location | |||
* Differentiate between thrombus, [[pannus]] and vegetations | |||
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" | | |||
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |Causes: | |||
* Thrombus | |||
* Pannus formation | |||
|- | |||
| colspan="10" | | |||
|- | |||
|style="vertical-align: top;background: #DCDCDC; padding: 5px; text-align: center;" |[[Cor Triatriatum]] | |||
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" | | |||
* Dyspnea on exertion | |||
* Recent onset of [[congestive heart failure]] | |||
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" | | |||
* Dsypnea on exertion | |||
* Orthopnea | |||
* Tachypnea | |||
* Palpitations | |||
* Growth failure | |||
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Auscultation''' | |||
* Murmur | |||
'''Other findings''' | |||
* Signs of heart failure | |||
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" | | |||
* Diastolic murmur with loud P2 | |||
* No opening snap or a loud S1 | |||
| | |style="vertical-align: top;background: #F5F5F5; padding: 5px;" |Non specific but may have | ||
| | * [[Right axis deviation]] | ||
* Right atrial enlargement | |||
* [[Right ventricular hypertrophy]] | |||
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" | | |||
* Normal cardiac silhouette | |||
* Hemodynamic changes similar to mitral stenosis (non specific findings) | |||
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" | | |||
* Direct visualization of membrane through the atrium | |||
* +/- visualization of accessory chamber | |||
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" | | |||
* Normal left ventricular hemodynamic profile with a trans atrial gradient | |||
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |Types | |||
* Cor triatriatum sinistrum | |||
* Cor triatriatum dextrum | |||
|- | |||
| colspan="10" | | |||
|- | |||
|style="vertical-align: top;background: #DCDCDC; padding: 5px; text-align: center;" |Congenital Mitral Stenosis | |||
| style="vertical-align: top;background: #F5F5F5; padding: 5px;" | | |||
* Respiratory distress shortly after birth | |||
* Recurrent severe pulmonary infections | |||
* Other associated congenital cardiovascular anamolies | |||
* [[Atrial fibrillation]] | |||
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" | | |||
'''Infants:''' | |||
* Exhaustion and sweating on feeding | |||
* Rapid breathing | |||
* [[Failure to thrive]] | |||
* Pulmonary infections | |||
* Chronic cough | |||
'''Older patients:''' | |||
* Dyspnea | |||
* Orthopnea | |||
* Paroxysmal nocturnal dyspnea | |||
* Peripheral edema | |||
* Fatigue | |||
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Auscultation''' | |||
* Murmur | |||
'''Other findings''' | |||
* Signs of heart failure | |||
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Mild-Moderate''' | |||
* Loud S1 | |||
* Loud P2 | |||
* Low frequency diastolic murmur best heard at the apex | |||
'''Severe''' | |||
* Soft S1 | |||
* Loud pulmonic component of S2 with minimal respiratory splitting of S2 | |||
* Holodiastolic murmur with presystolic accentuation best heard at the apex | |||
* Early diastolic murmur of pulmonic valve regurgitation | |||
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" | | |||
*Sharp P waves in leads I and II | |||
*Inversion of P wave in lead III | |||
*Marked Q waves in leads II and III | |||
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" | | |||
* Left atrial dilation | |||
* Moderate enlargement of right heart | |||
* Pulmonary venous congestion | |||
* Esophageal compression | |||
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" | | |||
* Reduced valve leaflet mobility | |||
* Left atrial size | |||
* Severity of mitral stenosis | |||
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" | | |||
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |Very rare condition | |||
|- | |||
| colspan="10" | | |||
|- | |- | ||
|style="vertical-align: top;background: #DCDCDC; padding: 5px; text-align: center;" |Supravalvular Ring Mitral Stenosis | |||
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" | | |||
* Other associated congenital heart defects | |||
* Fatigue | |||
* Frequent respiratory infections | |||
* Failure to thrive | |||
* Poor feeding | |||
* Precocious congestive heart failure | |||
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" | | |||
* Shortness of breath | |||
| style=" | * Tachypnea | ||
* Dyspnea | |||
* Nocturnal cough | |||
* Heamoptysis | |||
* [[Syncope]] | |||
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Auscultation:''' | |||
Lungs: Fine, crepitant rales and rhonchi or wheezes may be present | |||
| style=" | Heart: Murmur | ||
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" | | |||
* An apical mid diastolic murmur with presystolic accentuation | |||
* No opening snap | |||
* The murmur is more prominent if associated with [[VSD]] or [[PDA]] | |||
|- | |style="vertical-align: top;background: #F5F5F5; padding: 5px;" | | ||
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" | | |||
* Left atrial and ventricular enlargement | |||
* Alveolar edema | |||
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Supramitral ring''': | |||
* Associated with normal mitral valve apparatus | |||
'''Intramitral ring:''' | |||
* Hypomobility of the posterior leaflet | |||
* Reduced interpapillary muscle distance | |||
* Reduced chordal length | |||
* Dominant papillary muscle | |||
* Hypoplastic mitral annulus | |||
(Difficult to visualize membrane <1mm in size) | |||
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" | | |||
* Persistently elevated pulmonary venous pressures | |||
* Increased pulmonary artery pressure | |||
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Types''' | |||
* Supramitral | |||
* Intramitral | |||
It is attached between the opening of the atrial appendage and the mitral annulus which helps in differentiating with Cor triatriatum sinister. | |||
* Intramitral type is associated with shone complex | |||
|} |
Latest revision as of 16:05, 16 May 2020
Wikidoc practice session
“ | I can't wait for covid to be over! | ” |
Synonyms and keywords:
Classification of dextrocardia
Dextrocardia Types | Description |
---|---|
Dextrocardia with situs solitus |
|
Dextrocardia with situs inversus |
|
Dextrocardia with situs ambiguous (either polyspenia or asplenia) |
|
Diseases | Clinical manifestations | Para-clinical findings | Gold standard | Additional findings | |||||||
---|---|---|---|---|---|---|---|---|---|---|---|
Symptoms | Physical examination | ||||||||||
Imaging | |||||||||||
Exertional dyspnea | Failure to thrive | Recurrent respiratory infections | Murmur on auscultation | Peripheral edema | Clubbing | Echocardiography | Chest x-ray | Cardiac CT | |||
Patent foramen ovale | − | − | − | − | − | − |
|
Non specific |
|
|
|
Atrial septal defect | +/− | +/− | +/− |
|
+/− | +/− |
|
|
|
|
|
Ventricular septal defect | -/+ | -/+ | After Eisenmenger syndrome |
|
-/+ | -/+ |
|
|
|
|
|
Diseases | Exertional dyspnea | Failure to thrive | Recurrent respiratory infections | Murmur on auscultation | Peripheral edema | Clubbing | Echocardiography | Chest x-ray | Cardiac CT | Gold standard | Additional findings |
Patent ductus arteriosus |
|
|
- |
|
- |
|
|
|
|
|
|
Coarctation of the aorta | +/− | +/− | − |
|
− | − |
|
|
|
|
|
Aortic stenosis | + | + | + |
|
+/- |
|
|
|
|
| |
Pulmonary stenosis |
|
- | -/+ |
|
- | -/+ |
|
|
|
|
Diseases | Pathophysiology | Shunt | Symptoms | Diagnosis | Echocardiography findings | Physical examination | Treatment | Complications |
---|---|---|---|---|---|---|---|---|
Patent foramen ovale |
|
|
|
|
|
|
| |
Atrial septal defect |
|
|
|
|
|
|
|
|
Pulmonary ateriovenous fistula |
|
|
|
|
|
|
|
|
Differential table for aortic stenosis
Diseases | History | Symptoms | Physical Examination | Murmur | Diagnosis | Other Findings | |||
---|---|---|---|---|---|---|---|---|---|
ECG | CXR | Echocardiogram | Cardiac Catheterization | ||||||
Aortic stenosis |
|
|
|
|
Left ventricular hypertrophy:
|
|
|
Left heart catheterization:
|
|
Mitral Stenosis |
|
|
|
|
|
|
|
Right heart catheterization:
Left heart catheterization:
|
|
Mitral Regurgitation |
|
|
Palpation
Auscultation
|
|
|
Acute MR
Chronic MR
|
|
|
|
Atrial septal defect |
|
|
Inspection
Palpation
Auscultation
|
|
|
|
|
|
|
Left Atrial Myxoma |
|
|
Skin
Auscultation:
|
|
|
Rare findings:
|
|
|
|
Prosthetic Valve Obstruction |
|
|
Ausculation
Muffling of murmur |
|
− | − |
|
Causes:
| |
Cor Triatriatum |
|
|
Auscultation
Other findings
|
|
Non specific but may have
|
|
|
|
Types
|
Congenital Mitral Stenosis |
|
Infants:
Older patients:
|
Auscultation
Other findings
|
Mild-Moderate
Severe
|
|
|
|
Very rare condition | |
Supravalvular Ring Mitral Stenosis |
|
|
Auscultation:
Lungs: Fine, crepitant rales and rhonchi or wheezes may be present Heart: Murmur |
|
|
Supramitral ring:
Intramitral ring:
(Difficult to visualize membrane <1mm in size) |
|
Types
It is attached between the opening of the atrial appendage and the mitral annulus which helps in differentiating with Cor triatriatum sinister.
|