Left atrial enlargement causes: Difference between revisions

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{{CMG}}; {{AOEIC}} {{VK}}
{{CMG}}; {{AOEIC}} {{VK}}


==Overview==
In the general population, [[obesity]] appears to be the most important [[risk factor]] for left atrial enlargement.<ref name='Stritzke2009'>{{cite journal|title=The Aging Process of the Heart: Obesity Is the Main Risk Factor for Left Atrial Enlargement During Aging: The MONICA/KORA (Monitoring of Trends and Determinations in Cardiovascular Disease/Cooperative Research in the Region of Augsburg) Study |journal=Journal of the American College of Cardiology|date=2009-11-17|author=Stritzke J, Markus MRP, Duderstadt S, Lieb W, Luchner A, Döring A, Keil U, Hense H and Schunkert H|volume=54|issue=21|pages=1982–9|pmid=19909880  |doi=10.1016/j.jacc.2009.07.034 |url=http://content.onlinejacc.org/cgi/content/abstract/54/21/1982|format=|accessdate=2009-12-02 }}</ref> Persistent [[atrial fibrillation]] results in retention of blood in the left atrium secondary to inadequate pumping of blood by the atrium into the left ventricle<ref name='Sanfilippo1990'>{{cite journal|title=Atrial enlargement as a consequence of atrial fibrillation  A prospective echocardiographic study|journal=Circulation|year=1990|author=Sanfilippo AJ, Abascal VM, Sheehan M, Oertel LB, Harrigan P, Hughes RA and Weyman AE |volume=82|issue=3|pages=792–7|pmid= 2144217 |url=http://circ.ahajournals.org/cgi/content/abstract/82/3/792|format=|accessdate=2009-12-02|doi=10.1161/01.CIR.82.3.792}}</ref>. Similar pathophysiologic process occurs in [[mitral stenosis]] resulting in subsequent left atrial enlargement. [[Aortic stenosis]], [[mitral regurgitation]], [[aortic insufficiency]] and other causes of [[left ventricular heart failure]] causes an increase in back pressure within the atrium resulting in subsequent left atrial enlargement.
==Differential Diagnosis of Causes of Left Atrial Enlargement==
==Differential Diagnosis of Causes of Left Atrial Enlargement==
===In alphabetical Order===
===By Organ System===
*[[Alcoholism]]
{|style="width:75%" height:100px" border="1"
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" | '''Cardiovascular'''
|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | [[Aortic regurgitation]], [[Aortic stenosis]], [[Atrial fibrillation]]<ref name='Sanfilippo1990'>{{cite journal|title=Atrial enlargement as a consequence of atrial fibrillation  A prospective echocardiographic study|journal=Circulation|year=1990|author=Sanfilippo AJ, Abascal VM, Sheehan M, Oertel LB, Harrigan P, Hughes RA and Weyman AE |volume=82|issue=3|pages=792–7|pmid= 2144217 |url=http://circ.ahajournals.org/cgi/content/abstract/82/3/792|format=|accessdate=2009-12-02|doi=10.1161/01.CIR.82.3.792}}</ref>, [[Atrial septal defect]], [[Cardiac amyloidosis]]<ref name="pmid12413446">{{cite journal |author=Dardas PS, Tsikaderis DD, Mezilis N, Geleris P, Boudoulas H |title=Echocardiographic evidence of atrial myopathy in amyloidosis: a case report |journal=[[European Journal of Echocardiography : the Journal of the Working Group on Echocardiography of the European Society of Cardiology]] |volume=3 |issue=4 |pages=303–5 |year=2002 |month=December |pmid=12413446 |doi= |url=http://ejechocard.oxfordjournals.org/cgi/pmidlookup?view=long&pmid=12413446 |accessdate=2012-04-17}}</ref>, [[Coarctation of the aorta]], [[Congestive heart failure]], [[Coronary artery disease]], [[Hypertrophic cardiomyopathy]], Hypoplasia of mitral valve annulus which is a part of the spectrum of [[hypoplastic left heart syndrome]], [[Infective endocarditis]], [[Ischemic mitral regurgitation]], [[Left atrial myxoma]], [[Left bundle branch block]], [[Mitral regurgitation]], [[Mitral stenosis]], Mitral valve annular [[calcification]], Mitral valve commissural fusion, [[Mitral valve prolapse]], [[Papillary muscle rupture]], Parachute mitral valve, [[Prosthetic mitral valve]] stenosis, [[Rheumatic heart disease]], Supra-valve mitral membrane, [[Systemic hypertension]], Thickened [[chordae tendinae]], [[Thrombus]] (ball valve thrombus) in left atrium
|-
|-bgcolor="LightSteelBlue"
| '''Chemical / poisoning'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Dermatologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Drug Side Effect'''
|bgcolor="Beige"| [[Chronic alcoholism]]<ref>Kabir J. Singh, Beth Cohen, Bee Ya Na, Mary A. Whooley, and Nelson B. Schiller. Predictors Of Increasing Left Atrial Volume Over Five Years In Coronary Artery Disease Patients: Results From The Heart And Soul Study. J.Am.Coll.Cardiol.2010;55;A91.E864 [http://content.onlinejacc.org/cgi/reprint/55/10_MeetingAbstracts/A91.E864.pdf]</ref>
|-
|-bgcolor="LightSteelBlue"
| '''Ear Nose Throat'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Endocrine'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Environmental'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Gastroenterologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Genetic'''
|bgcolor="Beige"| [[Cardiac amyloidosis]]<ref name="pmid12413446">{{cite journal |author=Dardas PS, Tsikaderis DD, Mezilis N, Geleris P, Boudoulas H |title=Echocardiographic evidence of atrial myopathy in amyloidosis: a case report |journal=[[European Journal of Echocardiography : the Journal of the Working Group on Echocardiography of the European Society of Cardiology]] |volume=3 |issue=4 |pages=303–5 |year=2002 |month=December |pmid=12413446 |doi= |url=http://ejechocard.oxfordjournals.org/cgi/pmidlookup?view=long&pmid=12413446 |accessdate=2012-04-17}}</ref>, [[Hypertrophic cardiomyopathy]], [[Hypoplasia]] of mitral valve annulus which is a part of the spectrum of [[hypoplastic left heart syndrome]]
|-
|-bgcolor="LightSteelBlue"
| '''Hematologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Iatrogenic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Infectious Disease'''
|bgcolor="Beige"| [[Infective endocarditis]], [[Pneumonia]], [[Rheumatic heart disease]]
|-
|-bgcolor="LightSteelBlue"
| '''Musculoskeletal / Ortho'''
|bgcolor="Beige"| [[Ankylosing spondylitis]]
|-
|-bgcolor="LightSteelBlue"
| '''Neurologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Nutritional / Metabolic'''
|bgcolor="Beige"| [[Hypercholesterolemia]] accelerates the stenotic process of the valves via [[calcification]], [[Obesity]]
|-
|-bgcolor="LightSteelBlue"
| '''Obstetric/Gynecologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Oncologic'''
|bgcolor="Beige"| [[Left atrial myxoma]]
|-
|-bgcolor="LightSteelBlue"
| '''Opthalmologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Overdose / Toxicity'''
|bgcolor="Beige"| [[Chronic alcoholism]]<ref>Kabir J. Singh, Beth Cohen, Bee Ya Na, Mary A. Whooley, and Nelson B. Schiller. Predictors Of Increasing Left Atrial Volume Over Five Years In Coronary Artery Disease Patients: Results From The Heart And Soul Study. J.Am.Coll.Cardiol.2010;55;A91.E864 [http://content.onlinejacc.org/cgi/reprint/55/10_MeetingAbstracts/A91.E864.pdf]</ref>
|-
|-bgcolor="LightSteelBlue"
| '''Psychiatric'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Pulmonary'''
|bgcolor="Beige"| [[Emphysema]], [[Pneumonia]]
|-
|-bgcolor="LightSteelBlue"
| '''Renal / Electrolyte'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Rheum / Immune / Allergy'''
|bgcolor="Beige"| [[Ankylosing spondylitis]], [[Cardiac amyloidosis]]<ref name="pmid12413446">{{cite journal |author=Dardas PS, Tsikaderis DD, Mezilis N, Geleris P, Boudoulas H |title=Echocardiographic evidence of atrial myopathy in amyloidosis: a case report |journal=[[European Journal of Echocardiography : the Journal of the Working Group on Echocardiography of the European Society of Cardiology]] |volume=3 |issue=4 |pages=303–5 |year=2002 |month=December |pmid=12413446 |doi= |url=http://ejechocard.oxfordjournals.org/cgi/pmidlookup?view=long&pmid=12413446 |accessdate=2012-04-17}}</ref>, [[Rheumatic heart disease]]
|-
|-bgcolor="LightSteelBlue"
| '''Sexual'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Trauma'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Urologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Miscellaneous'''
|bgcolor="Beige"| [[Thrombus]] (ball valve thrombus) in left atrium
|-
|}
 
 
===In Alphabetical Order===
 
*[[Ankylosing spondylitis]]
*[[Ankylosing spondylitis]]
*[[Aortic regurgitation]]
*[[Aortic regurgitation]]
*[[Aortic stenosis]]
*[[Aortic stenosis]]
*[[Atrial fibrillation]]
*[[Atrial fibrillation]]<ref name='Sanfilippo1990'>{{cite journal|title=Atrial enlargement as a consequence of atrial fibrillation  A prospective echocardiographic study|journal=Circulation|year=1990|author=Sanfilippo AJ, Abascal VM, Sheehan M, Oertel LB, Harrigan P, Hughes RA and Weyman AE |volume=82|issue=3|pages=792–7|pmid= 2144217 |url=http://circ.ahajournals.org/cgi/content/abstract/82/3/792|format=|accessdate=2009-12-02|doi=10.1161/01.CIR.82.3.792}}</ref>
*[[Atrial septal defect]]
*[[Atrial septal defect]]
*[[Cardiac amyloidosis]]<ref name="pmid12413446">{{cite journal |author=Dardas PS, Tsikaderis DD, Mezilis N, Geleris P, Boudoulas H |title=Echocardiographic evidence of atrial myopathy in amyloidosis: a case report |journal=[[European Journal of Echocardiography : the Journal of the Working Group on Echocardiography of the European Society of Cardiology]] |volume=3 |issue=4 |pages=303–5 |year=2002 |month=December |pmid=12413446 |doi= |url=http://ejechocard.oxfordjournals.org/cgi/pmidlookup?view=long&pmid=12413446 |accessdate=2012-04-17}}</ref>
*[[Chronic alcoholism]]<ref>Kabir J. Singh, Beth Cohen, Bee Ya Na, Mary A. Whooley, and Nelson B. Schiller. Predictors Of Increasing Left Atrial Volume Over Five Years In Coronary Artery Disease Patients: Results From The Heart And Soul Study. J.Am.Coll.Cardiol.2010;55;A91.E864 [http://content.onlinejacc.org/cgi/reprint/55/10_MeetingAbstracts/A91.E864.pdf]</ref>
*[[Coarctation of the aorta]]
*[[Coarctation of the aorta]]
*[[Congestive heart failure]]
*[[Congestive heart failure]]
*[[Coronary artery disease]]
*[[Emphysema]]
*[[Emphysema]]
*[[Hypertrophic cardiomyopathy]]
*[[Hypertrophic cardiomyopathy]]
Line 28: Line 145:
*Parachute mitral valve
*Parachute mitral valve
*[[Pneumonia]]
*[[Pneumonia]]
*[[Prosthetic mitral valve]]
*[[Prosthetic mitral valve]] stenosis
*[[Rheumatic heart disease]]
*[[Rheumatic heart disease]]
*Supra-valve mitral membrane
*Supra-valve mitral membrane

Latest revision as of 16:29, 17 April 2012

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [4]; Associate Editor(s)-In-Chief: Varun Kumar, M.B.B.S. [5]

Overview

In the general population, obesity appears to be the most important risk factor for left atrial enlargement.[1] Persistent atrial fibrillation results in retention of blood in the left atrium secondary to inadequate pumping of blood by the atrium into the left ventricle[2]. Similar pathophysiologic process occurs in mitral stenosis resulting in subsequent left atrial enlargement. Aortic stenosis, mitral regurgitation, aortic insufficiency and other causes of left ventricular heart failure causes an increase in back pressure within the atrium resulting in subsequent left atrial enlargement.

Differential Diagnosis of Causes of Left Atrial Enlargement

By Organ System

Cardiovascular Aortic regurgitation, Aortic stenosis, Atrial fibrillation[2], Atrial septal defect, Cardiac amyloidosis[3], Coarctation of the aorta, Congestive heart failure, Coronary artery disease, Hypertrophic cardiomyopathy, Hypoplasia of mitral valve annulus which is a part of the spectrum of hypoplastic left heart syndrome, Infective endocarditis, Ischemic mitral regurgitation, Left atrial myxoma, Left bundle branch block, Mitral regurgitation, Mitral stenosis, Mitral valve annular calcification, Mitral valve commissural fusion, Mitral valve prolapse, Papillary muscle rupture, Parachute mitral valve, Prosthetic mitral valve stenosis, Rheumatic heart disease, Supra-valve mitral membrane, Systemic hypertension, Thickened chordae tendinae, Thrombus (ball valve thrombus) in left atrium
Chemical / poisoning No underlying causes
Dermatologic No underlying causes
Drug Side Effect Chronic alcoholism[4]
Ear Nose Throat No underlying causes
Endocrine No underlying causes
Environmental No underlying causes
Gastroenterologic No underlying causes
Genetic Cardiac amyloidosis[3], Hypertrophic cardiomyopathy, Hypoplasia of mitral valve annulus which is a part of the spectrum of hypoplastic left heart syndrome
Hematologic No underlying causes
Iatrogenic No underlying causes
Infectious Disease Infective endocarditis, Pneumonia, Rheumatic heart disease
Musculoskeletal / Ortho Ankylosing spondylitis
Neurologic No underlying causes
Nutritional / Metabolic Hypercholesterolemia accelerates the stenotic process of the valves via calcification, Obesity
Obstetric/Gynecologic No underlying causes
Oncologic Left atrial myxoma
Opthalmologic No underlying causes
Overdose / Toxicity Chronic alcoholism[5]
Psychiatric No underlying causes
Pulmonary Emphysema, Pneumonia
Renal / Electrolyte No underlying causes
Rheum / Immune / Allergy Ankylosing spondylitis, Cardiac amyloidosis[3], Rheumatic heart disease
Sexual No underlying causes
Trauma No underlying causes
Urologic No underlying causes
Miscellaneous Thrombus (ball valve thrombus) in left atrium


In Alphabetical Order

References

  1. ↑ Stritzke J, Markus MRP, Duderstadt S, Lieb W, Luchner A, Döring A, Keil U, Hense H and Schunkert H (2009-11-17). "The Aging Process of the Heart: Obesity Is the Main Risk Factor for Left Atrial Enlargement During Aging: The MONICA/KORA (Monitoring of Trends and Determinations in Cardiovascular Disease/Cooperative Research in the Region of Augsburg) Study". Journal of the American College of Cardiology. 54 (21): 1982–9. doi:10.1016/j.jacc.2009.07.034. PMID 19909880. Retrieved 2009-12-02.
  2. ↑ 2.0 2.1 2.2 Sanfilippo AJ, Abascal VM, Sheehan M, Oertel LB, Harrigan P, Hughes RA and Weyman AE (1990). "Atrial enlargement as a consequence of atrial fibrillation A prospective echocardiographic study". Circulation. 82 (3): 792–7. doi:10.1161/01.CIR.82.3.792. PMID 2144217. Retrieved 2009-12-02.
  3. ↑ 3.0 3.1 3.2 3.3 Dardas PS, Tsikaderis DD, Mezilis N, Geleris P, Boudoulas H (2002). "Echocardiographic evidence of atrial myopathy in amyloidosis: a case report". European Journal of Echocardiography : the Journal of the Working Group on Echocardiography of the European Society of Cardiology. 3 (4): 303–5. PMID 12413446. Retrieved 2012-04-17. Unknown parameter |month= ignored (help)
  4. ↑ Kabir J. Singh, Beth Cohen, Bee Ya Na, Mary A. Whooley, and Nelson B. Schiller. Predictors Of Increasing Left Atrial Volume Over Five Years In Coronary Artery Disease Patients: Results From The Heart And Soul Study. J.Am.Coll.Cardiol.2010;55;A91.E864 [1]
  5. ↑ Kabir J. Singh, Beth Cohen, Bee Ya Na, Mary A. Whooley, and Nelson B. Schiller. Predictors Of Increasing Left Atrial Volume Over Five Years In Coronary Artery Disease Patients: Results From The Heart And Soul Study. J.Am.Coll.Cardiol.2010;55;A91.E864 [2]
  6. ↑ Kabir J. Singh, Beth Cohen, Bee Ya Na, Mary A. Whooley, and Nelson B. Schiller. Predictors Of Increasing Left Atrial Volume Over Five Years In Coronary Artery Disease Patients: Results From The Heart And Soul Study. J.Am.Coll.Cardiol.2010;55;A91.E864 [3]

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