Pulmonic regurgitation differential diagnosis: Difference between revisions

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{{CMG}}
{{CMG}}
==Overview==


==Differential diagnosis of underlying causes==
==Differential diagnosis of pulmonic 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
|+
! style="background: #4479BA; width: 120px;" | {{fontcolor|#FFF|Disease}}
! style="background: #4479BA; width: 550px;" | {{fontcolor|#FFF|Findings}}
|-
| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Pulmonary Valve Regurgitation]]'''
| style="padding: 5px 5px; background: #F5F5F5;" |
*PR is best heard over the left second and third interspaces and increases with inspiration
*Usually secondary to repair of tetralogy of Fallot or pulmonic Valve stenosis.
|-
| 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 is heard over left sternal border or over the right second interspace and radiates to the neck
|-
| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Tricuspid Regurgitation causing RV enlargement]]'''
| style="padding: 5px 5px; background: #F5F5F5;" |
*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 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 acyanotic congenital disease such as ASD
*Fixed splitting of S2 is present
|-
| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Arrthmogenic 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" waves and epsilon waves with selective "S" wave delay in V1 to V3
*RV is dilated and hypokinetic on echocardiography
*Holter is the diagnostic test to diagnose hyperkinetic ventricular arrythmias
|-
|}
==Other differential diagnosis==
* [[Pulmonary hypertension]]
* [[Pulmonary hypertension]]
*[[Infective endocarditis]]
*[[Infective endocarditis]]

Revision as of 21:32, 29 December 2016

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Differential diagnosis of pulmonic regurgitation

The diseases which may present with overlapping symptoms as pulmonic regurgitation may include the following:

Disease Findings
Pulmonary Valve Regurgitation
  • PR is best heard over the left second and third interspaces and increases with inspiration
  • Usually secondary to repair of tetralogy of Fallot or pulmonic Valve stenosis.
Aortic Regurgitation
  • Patients present with dyspnea and fatigability as a consequence of reduced cardiac reserve in the fourth or fifth decade[1]
  • AR is heard over left sternal border or over the right second interspace and radiates to the neck
Tricuspid Regurgitation causing RV enlargement
  • Pansystolic murmur accentuating with inspiration[2]
  • RV heave
  • Gaint "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[3]
Left to Right Shunt causing RV enlargement
  • Usually seen in children with acyanotic congenital disease such as ASD
  • Fixed splitting of S2 is present
Arrthmogenic Right Ventricular Cardiomyopathy
  • Gradual replacement of normal functional myocardium with adipose or fibroadipose tissue[4]
  • Age of onset is 7 to 40years
  • Patients are usually asymptomatic, present with occasional palpitations
  • EKG shows negative "T" waves and epsilon waves with selective "S" wave delay in V1 to V3
  • RV is dilated and hypokinetic on echocardiography
  • Holter is the diagnostic test to diagnose hyperkinetic ventricular arrythmias

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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