Right ventricular outflow tract obstruction differential diagnosis

Right ventricular outflow tract obstruction Microchapters
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]; Keri Shafer, M.D. [3]

Overview

Right ventricular outflow tract obstruction must be distinguished from an ASD

Differentiating Right ventricular outflow tract obstruction from other Diseases

Right ventricular outflow tract obstruction must be distinguished from several other conditions.

1. Atrial septal defect: Also has a systolic ejection murmur, wide fixed split S2, EKG showing RVH. In ASD the split of the S2 is fixed, there is no ejection click.

2. Small Ventricular septal defect: Amyl nitrate increases venous return and increases the murmur of pulmonary stenosis, in VSD the murmur becomes softer.

3. Mild left-sided outflow obstruction: With valsalva maneuver the murmur of aortic stenosis becomes softer after about 5 beats, with pulmonary stenosis it becomes softer within 3 beats.

4. Acyanotic or pink tetralogy of Fallot: with amyl nitrate and increased venous return the murmur of PS increases, and the murmur of tetralogy decreases because of peripheraldilation and an increase in right to left shunting.