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
|
−
|
−
|
−
|
−
|
−
|
−
|
- Appearance of at least 3 micro-bubbles in the left atrium within three cardiac cycles after complete opacification of the right atrium
|
Non specific
|
−
|
|
- It is associated with paradoxical embolism, migraine headache, and decompression sickness in divers
|
Atrial septal defect
|
+/−
|
+/−
|
+/−
|
- Systolic flow murmur in the upper left sternal border
- Wide, fixed splitting of S2
- Diastolic flow rumble across the tricuspid valve
|
+/−
|
+/−
|
- Hypermobile interatrial septum
- Abrupt septal irregularity
- Right atrial and ventricular volume overload
- Pulmonary artery dilatation
|
- Cardiomegaly
- Pulmonary artery enlargement/increased pulmonary vascularity
|
|
|
|
Ventricular septal defect
|
-/+
|
-/+
|
After Eisenmenger syndrome
|
- Holosystolic murmur
- May mimic aortic stenosis(mid/end dyastolic murmur due to increased pulmonary circulation)
|
-/+
|
-/+
|
- 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
|
|
- Direct visualisation of murmur
|
|
|
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
|
- Not at beginning
- May be produced during the course of disease
|
|
-
|
- Continuous machine-like murmur
|
-
|
- May be present by progressing
|
- Golden standard
- In color-Doppler visualization of flow through the patent duct which has a high velocity
|
|
- Used for determining Krichenko classification
|
|
- Krichenko criteria for classification is a very important factor for treatment
|
Coarctation of the aorta
|
+/−
|
+/−
|
−
|
- Systolic murmur over the upper sternal border with radiation to the back
- Murmur of mitral regurgitation (holosystolic murmur best heard at the apex)
|
−
|
−
|
- Narrowing of the aortic arch at the level of the isthmus
- Left ventricular hypertrophy
|
- 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")
|
- Dilation of the intercostal arteries
|
|
- Patients present with arm-leg blood pressure gradient of >2ommHg
|
Aortic stenosis
|
+
|
+
|
+
|
- Crescendo-decrescendo mid-systolic (or ejection systolic) murmur
|
+/-
|
|
- Used for finding the location of stenosis
- Finding severity
- Evaluating the flow jet with color-Doppler ultrasound technique
|
- Non-specific at the beginning
- At progressed stage calcification of the valve and cardiomegally
|
|
|
- MRI provides a more detailed structural and dynamic assessment of the aortic valve and left ventricle, in particular
|
Pulmonary stenosis
|
|
-
|
-/+
|
- Continuous systolic murmur
|
-
|
-/+
|
|
|
- Direct visualization of stenosis
|
|
|
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.
|
- More prominent with increased right atrial pressure.
|
- Majority of patients are asymptomatic
|
|
- 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
|
- 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 |
|
Type 2 |
|
Type 3 |
- Little or zero overlap (< 3 mm)
|
Patent foramen ovale may be diagnosed with cardiac CT angiography using 64-MDCT (multidetector computed tomography.
|
Diseases
|
Anatomy
|
Shunt
|
Symptoms
|
Physical Education
|
Diagnosis
|
Treatment
|
Complications
|
Type 1 |
|
Type 2 |
|
Type 3 |
- Little or zero overlap (< 3 mm)
|