Pulmonic regurgitation differential diagnosis: Difference between revisions
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| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Aortic Regurgitation]]''' | | style="padding: 5px 5px; background: #DCDCDC;" | '''[[Aortic Regurgitation]]''' | ||
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*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> | *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 | *[[AR]] [[murmur]] is heard over left sternal border or over the right second [[intercostal space]] and radiates to the neck | ||
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| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Tricuspid Regurgitation causing | | style="padding: 5px 5px; background: #DCDCDC;" | '''[[Tricuspid Regurgitation]] causing [[right vetricular]] enlargement''' | ||
| style="padding: 5px 5px; background: #F5F5F5;" | | | 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> | *[[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 | *RV heave | ||
*Gaint "V" wave seen on JVP examination | *Gaint "V" wave seen on [[JVP]] examination | ||
*Hepatomegaly is seen in 90% of patients | *[[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> | *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> | ||
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| style="padding: 5px 5px; background: #DCDCDC;" |'''Left to Right Shunt causing RV enlargement | | style="padding: 5px 5px; background: #DCDCDC;" |'''Left to Right Shunt]] causing RV enlargement | ||
| style="padding: 5px 5px; background: #F5F5F5;" | | | style="padding: 5px 5px; background: #F5F5F5;" | | ||
*Usually seen in children with acyanotic congenital disease such as ASD | *Usually seen in children with [[acyanotic congenital disease]] such as [[ASD]] | ||
*Fixed splitting of S2 is present | *Fixed splitting of [[S2]] is present | ||
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| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Arrthmogenic Right Ventricular Cardiomyopathy]]''' | | style="padding: 5px 5px; background: #DCDCDC;" | '''[[Arrthmogenic Right Ventricular Cardiomyopathy]]''' | ||
| style="padding: 5px 5px; background: #F5F5F5;" | | | 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> | *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 | *Age of onset is 7 to 40years | ||
*Patients are usually asymptomatic, present with occasional palpitations | *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 | *[[EKG]] shows negative "T" waves and epsilon waves with selective "S" wave delay in V1 to V3 | ||
*RV is dilated and hypokinetic on echocardiography | *[[RV]] is dilated and hypokinetic on [[echocardiography]] | ||
*Holter | *[[Holter monitoring]] helps to diagnose hyperkinetic [[ventricular arrythmias]] | ||
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Revision as of 15:52, 31 March 2017
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Pulmonic regurgitation Microchapters |
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Diagnosis |
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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
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.[1][2][3]
Differential diagnosis of pulmonic regurgitation
The diseases which may present with overlapping symptoms as pulmonic regurgitation may include the following:
| Disease | Findings |
|---|---|
| Aortic Regurgitation |
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| Tricuspid Regurgitation causing right vetricular enlargement |
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| Left to Right Shunt]] causing RV enlargement |
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| Arrthmogenic Right Ventricular Cardiomyopathy |
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Other differential diagnosis
- Pulmonary hypertension
- Infective endocarditis
- Rheumatic heart disease
- Congenital abnormalities: tetralogy of Fallot, ventricular septal defect, valvular pulmonic stenosis
- Carcinoid heart disease (the majority of patients with metastatic disease will have both pulmonic stenosis and pulmonic regurgitation)
- Marfan syndrome
- 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
- ↑ 1.0 1.1 Template:Citejournal
- ↑ 2.0 2.1 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.
- ↑ 3.0 3.1 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.
- ↑ 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.