Aortic regurgitation differential diagnosis: Difference between revisions
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The [[heart murmur]] of aortic regurgitation must be differentiated from that of other valvular diseases. Acute aortic regurgitation (AR) is characterized by the presence of a low pitched early diastolic murmur that is best heard at the right 2nd intercostal space, decreased or absent S1, and increased P2. Chronic AR is characterized by the presence of a high pitched holodiastolic decrescendo murmur that is best heard at the upper left sternal border and that increases with sitting forward, expiration, and handgrip. | The [[heart murmur]] of aortic regurgitation must be differentiated from that of other valvular diseases. Acute aortic regurgitation (AR) is characterized by the presence of a low pitched early diastolic murmur that is best heard at the right 2nd intercostal space, decreased or absent S1, and increased P2. Chronic AR is characterized by the presence of a high pitched holodiastolic decrescendo murmur that is best heard at the upper left sternal border and that increases with sitting forward, expiration, and handgrip. | ||
The differential diagnosis of aortic regurgitation includes other valvular abnormalities:<ref name="pmid24603191">{{cite journal| author=Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP, Guyton RA et al.| title=2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. | journal=J Am Coll Cardiol | year= 2014 | volume= 63 | issue= 22 | pages= e57-185 | pmid=24603191 | doi=10.1016/j.jacc.2014.02.536 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24603191 }} </ref><ref name="pmid27188578">{{cite journal| author=Lindman BR, Clavel MA, Mathieu P, Iung B, Lancellotti P, Otto CM et al.| title=Calcific aortic stenosis. | journal=Nat Rev Dis Primers | year= 2016 | volume= 2 | issue= | pages= 16006 | pmid=27188578 | doi=10.1038/nrdp.2016.6 | pmc=5127286 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27188578 }} </ref><ref name="pmid19747723">{{cite journal| author=Chandrashekhar Y, Westaby S, Narula J| title=Mitral stenosis. | journal=Lancet | year= 2009 | volume= 374 | issue= 9697 | pages= 1271-83 | pmid=19747723 | doi=10.1016/S0140-6736(09)60994-6 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19747723 }} </ref> | The differential diagnosis of aortic regurgitation includes other valvular abnormalities:<ref name="pmid24603191">{{cite journal| author=Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP, Guyton RA et al.| title=2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. | journal=J Am Coll Cardiol | year= 2014 | volume= 63 | issue= 22 | pages= e57-185 | pmid=24603191 | doi=10.1016/j.jacc.2014.02.536 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24603191 }} </ref><ref name="pmid27188578">{{cite journal| author=Lindman BR, Clavel MA, Mathieu P, Iung B, Lancellotti P, Otto CM et al.| title=Calcific aortic stenosis. | journal=Nat Rev Dis Primers | year= 2016 | volume= 2 | issue= | pages= 16006 | pmid=27188578 | doi=10.1038/nrdp.2016.6 | pmc=5127286 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27188578 }} </ref><ref name="pmid19747723">{{cite journal| author=Chandrashekhar Y, Westaby S, Narula J| title=Mitral stenosis. | journal=Lancet | year= 2009 | volume= 374 | issue= 9697 | pages= 1271-83 | pmid=19747723 | doi=10.1016/S0140-6736(09)60994-6 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19747723 }} </ref><ref name="pmid14565709">{{cite journal| author=Chockalingam A, Gnanavelu G, Elangovan S, Chockalingam V| title=Clinical spectrum of chronic rheumatic heart disease in India. | journal=J Heart Valve Dis | year= 2003 | volume= 12 | issue= 5 | pages= 577-81 | pmid=14565709 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14565709 }} </ref> | ||
* [[Aortic stenosis]]: The murmur of [[aortic stenosis]] is harsh and best heard at the right second intercostal space. | * [[Aortic stenosis]]: The murmur of [[aortic stenosis]] is harsh and best heard at the right second intercostal space. | ||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
The differential diagnosis of aortic regurgitation includes other valvular abnormalities and diseases that can cause a similar clinical presentation.
Differential Diagnosis
The heart murmur of aortic regurgitation must be differentiated from that of other valvular diseases. Acute aortic regurgitation (AR) is characterized by the presence of a low pitched early diastolic murmur that is best heard at the right 2nd intercostal space, decreased or absent S1, and increased P2. Chronic AR is characterized by the presence of a high pitched holodiastolic decrescendo murmur that is best heard at the upper left sternal border and that increases with sitting forward, expiration, and handgrip.
The differential diagnosis of aortic regurgitation includes other valvular abnormalities:[1][2][3][4]
- Aortic stenosis: The murmur of aortic stenosis is harsh and best heard at the right second intercostal space.
- Mitral regurgitation: The murmur of mitral regurgitation is blowing, soft and best heard at the apex.
- Mitral stenosis: The murmur of mitral stenosis is mid-diastolic, rumbling, and best heard after the opening snap.
- Tricuspid regurgitation: The murmur of tricuspid regurgitation is blowing, holosystolic, and best heard over the fourth intercostal area at the left sternal border.
- Tricuspid stenosis: The murmur of tricuspid stenosis is characterized by a mid diastolic murmur best heard over the left sternal border with rumbling character and tricuspid opening snap with wide splitting of S1.
Aortic regurgitation should also be differentiated from other diseases that might cause similar clinical presentation, such as:
- Acute coronary syndrome
- Anemia
- Heart failure
- Infective endocarditis
- Patent ductus arteriosus
- Pregnancy
- Thyrotoxicosis
- Volume depletion
- Wet beriberi
References
- ↑ Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP, Guyton RA; et al. (2014). "2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines". J Am Coll Cardiol. 63 (22): e57–185. doi:10.1016/j.jacc.2014.02.536. PMID 24603191.
- ↑ Lindman BR, Clavel MA, Mathieu P, Iung B, Lancellotti P, Otto CM; et al. (2016). "Calcific aortic stenosis". Nat Rev Dis Primers. 2: 16006. doi:10.1038/nrdp.2016.6. PMC 5127286. PMID 27188578.
- ↑ Chandrashekhar Y, Westaby S, Narula J (2009). "Mitral stenosis". Lancet. 374 (9697): 1271–83. doi:10.1016/S0140-6736(09)60994-6. PMID 19747723.
- ↑ Chockalingam A, Gnanavelu G, Elangovan S, Chockalingam V (2003). "Clinical spectrum of chronic rheumatic heart disease in India". J Heart Valve Dis. 12 (5): 577–81. PMID 14565709.