Pulmonic regurgitation differential diagnosis: Difference between revisions

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{{SI}}
[[Image:Home_logo1.png|right|250px|link=http://www.wikidoc.org/index.php/Pulmonic_regurgitation]]


{{CMG}}
{{CMG}}, {{AE}} {{AKI}}, {{AA}}
==Overview==
[[PR|Pulmonic regurgitation]] (PR) must be differentiated from other [[diseases]] that cause blowing [[Diastolic heart murmur|decrescendo murmur]] such as [[aortic regurgitation]]. The diseases which may present with overlapping symptoms as [[pulmonic regurgitation]] may include [[aortic regurgitation]], [[tricuspid regurgitation]], left to right shunting, right ventricular [[cardiomyopathy]], [[pulmonary hypertension]], [[infective endocarditis]], [[carcinoid]] heart disease, [[syphilis]] and [[marfan syndrome]].


{{EH}}
==Differential diagnosis of pulmonic regurgitation==
[[PR|Pulmonic regurgitation]] (PR) must be differentiated from other [[diseases]] that cause blowing [[Diastolic heart murmur|decrescendo murmur]] such as [[aortic regurgitation]]. The [[diseases]] which may present with overlapping [[symptoms]] as [[pulmonic regurgitation]] may include the following:
{| style="border: 0px; font-size: 90%; margin: 3px;" align=center
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! style="background: #4479BA; width: 120px;" | {{fontcolor|#FFF|Disease}}
! style="background: #4479BA; width: 550px;" | {{fontcolor|#FFF|Findings}}
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| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Aortic Regurgitation]]'''
| style="padding: 5px 5px; background: #F5F5F5;" |
*Patients present with [[dyspnea]] and [[fatigability]] as a consequence of reduced cardiac reserve in the fourth or fifth decade<ref name="GoldschlagerPfeifer1973">{{citejournal|last1=Goldschlager|first1=Nora|last2=Pfeifer|first2=James|last3=Cohn|first3=Keith|last4=Popper|first4=Robert|last5=Selzer|first5=Arthur|title=The natural history of aortic regurgitation|journal=The American Journal of Medicine|volume=54|issue=5|year=1973|pages=577–588|issn=00029343|doi=10.1016/0002-9343(73)90115-0}}</ref>
*[[AR]] [[murmur]] is heard over left sternal border or over the right second [[intercostal space]] and radiates to the neck
|-
| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Tricuspid Regurgitation]] causing [[right vetricular]] enlargement'''
| style="padding: 5px 5px; background: #F5F5F5;" |
*[[Murmur patterns#Holosystolic (Pansystolic) Murmur|Pansystolic murmur]] accentuating with [[inspiration]]<ref name="SepulvedaLukas1955">{{cite journal|last1=Sepulveda|first1=G.|last2=Lukas|first2=D. S.|title=The Diagnosis of Tricuspid Insufficiency: Clinical Features in 60 Cases with Associated Mitral Valve Disease|journal=Circulation|volume=11|issue=4|year=1955|pages=552–563|issn=0009-7322|doi=10.1161/01.CIR.11.4.552}}</ref>
*RV heave
*Gaint [[V wave|"V" wave]] seen on [[JVP]] examination
*[[Hepatomegaly]] is seen in 90% of patients
*Quantification of severity of [[TR]] is done by colour flow [[doppler]] imaging<ref name="Zoghbi2003">{{cite journal|last1=Zoghbi|first1=W|title=Recommendations for evaluation of the severity of native valvular regurgitation with two-dimensional and doppler echocardiography|journal=Journal of the American Society of Echocardiography|volume=16|issue=7|year=2003|pages=777–802|issn=08947317|doi=10.1016/S0894-7317(03)00335-3}}</ref>
|-
| style="padding: 5px 5px; background: #DCDCDC;" |'''Left to Right [[Shunt]] causing RV enlargement
| style="padding: 5px 5px; background: #F5F5F5;" |
*Usually seen in children with [[Congenital heart disease classification|acyanotic congenital disease]] such as [[ASD]]
*Fixed splitting of [[S2]] is present
|-
| style="padding: 5px 5px; background: #DCDCDC;" | '''Arrhythmogenic Right Ventricular Cardiomyopathy'''
| style="padding: 5px 5px; background: #F5F5F5;" |
*Gradual replacement of normal functional [[myocardium]] with [[adipose]] or fibroadipose tissue<ref name="pmid27828830">{{cite journal| author=Graziosi M, Rapezzi C| title=Right ventricular arrhythmogenic cardiomyopathy: genetic and MR for modern clinical diagnosis. | journal=J Cardiovasc Med (Hagerstown) | year= 2016 | volume=  | issue=  | pages=  | pmid=27828830 | doi=10.2459/JCM.0000000000000470 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27828830  }} </ref>
*Age of onset is 7 to 40years
*Patients are usually asymptomatic, present with occasional [[palpitations]]
*[[EKG]] shows negative [[T wave|"T" wave]]s and [[epsilon waves]] with selective "[[S wave|"S" wave]] delay in V1 to V3
*[[RV]] is dilated and hypokinetic on [[echocardiography]]
*[[Holter monitoring]] helps to [[diagnose]] hyperkinetic [[ventricular arrythmias]]
|-
|}


==Differential diagnosis of underlying causes==
==Other differential diagnosis==
 
* [[Pulmonary hypertension]]
[[Pulmonary hypertension]] |  [[Infective endocarditis]] | [[Rheumatic heart disease]]
*[[Infective endocarditis]]
*[[Congenital heart defect | Congenital abnormalities]]*: [[tetralogy of Fallot]], [[ventricular septal defect]], [[Pulmonic stenosis | valvular pulmonic stenosis]]
* [[Rheumatic heart disease]]
[[Carcinoid | Carcinoid heart disease]],  the majority of patients with metastatic disease will have both [[pulmonic stenosis]] and [[pulmonic regurgitation]]
*[[Congenital heart defect | Congenital abnormalities]]: [[tetralogy of Fallot]], [[ventricular septal defect]], [[Pulmonic stenosis | valvular pulmonic stenosis]]
| [[Marfan syndrome]] | Trauma from withdrawing a Swan-Ganz catheter with the balloon inflated. | Following [[valvuloplasty]] of [[pulmonary stenosis]] | [[Syphilis]] infection | absence of the pulmonic valve | Fenestrations in or redundant leaflets of the [[pulmonic valve]]
*[[Carcinoid | Carcinoid heart disease]] (the majority of patients with metastatic disease will have both [[pulmonic stenosis]] and [[pulmonic regurgitation]])
* [[Marfan syndrome]]
* [[Syphilis | Syphilis infection]]
* Trauma from withdrawing a Swan-Ganz catheter with the balloon inflated
* Following [[valvuloplasty]] of [[pulmonary stenosis]]  
* Absence of the pulmonic valve
* Fenestrations in or redundant leaflets of the [[pulmonic valve]]


==References==
==References==
{{reflist|2}}
{{Reflist}}


[[Category: Cardiology]]
[[Category: Cardiology]]

Latest revision as of 21:57, 6 August 2020

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1], Associate Editor(s)-in-Chief: Aravind Kuchkuntla, M.B.B.S[2], Aysha Anwar, M.B.B.S[3]

Overview

Pulmonic regurgitation (PR) must be differentiated from other diseases that cause blowing decrescendo murmur such as aortic regurgitation. The diseases which may present with overlapping symptoms as pulmonic regurgitation may include aortic regurgitation, tricuspid regurgitation, left to right shunting, right ventricular cardiomyopathy, pulmonary hypertension, infective endocarditis, carcinoid heart disease, syphilis and marfan syndrome.

Differential diagnosis of pulmonic regurgitation

Pulmonic regurgitation (PR) must be differentiated from other diseases that cause blowing decrescendo murmur such as aortic regurgitation. The diseases which may present with overlapping symptoms as pulmonic regurgitation may include the following:

Disease Findings
Aortic Regurgitation
  • Patients present with dyspnea and fatigability as a consequence of reduced cardiac reserve in the fourth or fifth decade[1]
  • AR murmur is heard over left sternal border or over the right second intercostal space and radiates to the neck
Tricuspid Regurgitation causing right vetricular enlargement
Left to Right Shunt causing RV enlargement
Arrhythmogenic Right Ventricular Cardiomyopathy

Other differential diagnosis

References

  1. ↑ Template:Citejournal
  2. ↑ Sepulveda, G.; Lukas, D. S. (1955). "The Diagnosis of Tricuspid Insufficiency: Clinical Features in 60 Cases with Associated Mitral Valve Disease". Circulation. 11 (4): 552–563. doi:10.1161/01.CIR.11.4.552. ISSN 0009-7322.
  3. ↑ Zoghbi, W (2003). "Recommendations for evaluation of the severity of native valvular regurgitation with two-dimensional and doppler echocardiography". Journal of the American Society of Echocardiography. 16 (7): 777–802. doi:10.1016/S0894-7317(03)00335-3. ISSN 0894-7317.
  4. ↑ Graziosi M, Rapezzi C (2016). "Right ventricular arrhythmogenic cardiomyopathy: genetic and MR for modern clinical diagnosis". J Cardiovasc Med (Hagerstown). doi:10.2459/JCM.0000000000000470. PMID 27828830.

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