Cardiomegaly: Difference between revisions

Jump to navigation Jump to search
VisualWikitext
No edit summary
No edit summary
Line 31: Line 31:
==[[Cardiomegaly causes|Causes]]==
==[[Cardiomegaly causes|Causes]]==


==[[Cardimegaly differential diagnosis|Differential diagnosis of cardiomegaly]]==
==[[Cardiomegaly differential diagnosis|Differential diagnosis of cardiomegaly]]==
 
In alphabetical order. <ref>Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016</ref> <ref>Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X</ref>
 
* [[Acromegaly]]
* [[Cardiomyopathy|Alcoholic cardiomyopathy]]
* [[Amyloidosis]]
* [[Anemia]]
* [[Primary Cardiac Tumors|Atrial myxoma]]
* [[Carcinoid]]
* [[Chronic Obstructive Pulmonary Disease]] ([[COPD]])
* [[Congenital heart disease]]
* [[Congestive Heart Failure]] [[CHF]]
* [[Ddx:Cor Pulmonale|Cor pulmonale]]
* [[Drug]]s
* [[Endocardial fibroelastosis]]
* Epicardial fat pad
* [[Fabry's Disease]]
* [[Hemochromatosis]]
* [[Hurler's Syndrome]]
* [[Hyperparathyroidism]]
* [[Hypertension]]
* [[HOCM|Hypertrophic cardiomyopathy]]
* [[Ddx:Hypocalcemia|Hypocalcemia]]
* [[Hypomagnesemia]]
* [[Hypoparathyroidism]]
* [[Hypophosphatemia]]
* [[Cardiomyopathy|Idiopathic cardiomyopathy]]
* [[CAD|Ischemic heart disease]]
* [[Kyphoscoliosis]]
* [[Marfan's Syndrome]]
* [[Mediastinal mass]]
* [[Myocarditis]]
* Normal, "athletic" heart
* [[Pompe's Disease]]
* [[Postradiation]]
* [[Pregnancy]]
* [[Primary pulmonary hypertension]]
* [[Pulmonary embolism]]
* [[Renal failure]]: [[Acute Renal Failure]] and [[Chronic Renal Failure]]
* [[Scleroderma]]
* [[Sickle cell disease]]
* [[Subacute bacterial endocarditis]]
* [[Systemic Lupus Erythematosus]]
* [[Valvular heart disease]]
 
== Differential Diagnosis of Specific Chamber Enlargements==
=== Left Atrial Enlargement ===
* [[Atrial]] [[aneurysm]]
* [[Infective endocarditis]]
* [[Left heart failure]]
* [[Mitral regurgitation]]
* [[Mitral stenosis]]
* [[Mitral valve prolapse]]
* [[Myxedma]]
* [[Patent Ductus Arteriosus]]
* [[Ventricular septal defect]]
 
=== Left Ventricular Hypertrophy ===
* [[Acromegaly]]
* [[Alcoholic cardiomyopathy]]
* [[Aortic coarctation]]
* [[Aortic regurgitation]]
* [[Aortic stenosis]]
* [[Chronic Renal Failure]]
* [[Familial dilated and hypertrophic cardiomyopathy]]
* [[Hypertrophic cardiomyopathy]] ([[HCM]])
* [[Idiopathic dilated cardiomyopathy]]
* [[Mitral regurgitation]]
* [[Patent Ductus Arteriosus]]
* [[Restrictive cardiomyopathy]]
* [[Thalassemia]]
 
=== Right Atrial Enlargement ===
* [[Atrial]] [[aneurysm]]
* [[Atrial septal defect]]
* [[Ebstein's anomaly]]
* [[Pulmonic stenosis]]
* [[Cor pulmonale|Right heart failure]]
* [[Tricuspid prolapse]]
* [[Tricuspid regurgitation]]
* [[Tricuspid stenosis]]
* [[Primary Cardiac Tumors|Tumor]]
 
=== Right Ventricular Hypertrophy ===
* [[Atrial septal defect]]
* [[Chronic Obstructive Pulmonary Disease]] ([[COPD]])
* [[Ddx:Cor Pulmonale|Cor pulmonale]]
* [[Eisenmenger's Syndrome]]
* [[Left ventricular hypertrophy]] or [[Left ventricular dilation]]
* [[Mitral stenosis]]
* [[Pickwickian Syndrome]]
* [[Pulmonic regurgitation]]
* [[Pulmonic stenosis]]
* [[Tetralogy of Fallot]]
* [[Transposition of the Great Vessels]]
* [[Tricuspid regurgitation]]
* [[Ventricular septal defect]]


== Diagnosis ==  
== Diagnosis ==  
 
[[Cardiomegaly history and symptoms|History and Symptoms]] | [[Cardiomegaly physical examination|Physical examination]] | [[Cardiomegaly laboratory tests|Lab tests]] | [[Cardiomegaly electrocardiogram|Electrocardiogram]] |  
=== History and Symptoms ===
* In the history, the physician should inquire as to:
*:* History of [[chest pain]] to suggest [[ischemic heart disease]]
*:* History of [[rheumatic fever]] or known [[valvular heart disease]]
*:* History of [[congenital heart disease]]
*:* History of [[drug]] and [[alcohol]] use (recreational)
*:* [[Family history]] (heart disease or sudden death)
* Associated symptoms:
*:* [[Dizziness]]
*:* [[Syncope]]
*:* [[Fatigue]]
*:* [[Dyspnea]]
*:* [[Palpitation]]s
 
=== Physical Examination ===
 
=== Heart ===
There is downward and leftward displacement of the heart on percussion of heart border. The heart should be percussed with the patient supine and the head of the bed elevated 30 degrees.
Normally the left heart border should not
*Extend left of the mid clavicular line
*Extend more than 10 cm to the left of the mid sternal line
*Occupy a diameter > 3 cm
*Extend below the 5th intercostal space
 
The body habitus of the individual must be taken into account in performing the examination. In athletic individuals who are thin, the impulse maybe strongly transmitted. In muscular or obese patients, the opposite is true. In patients with [[pectus excavatum]], the apex can be displaced laterally.
 
== Laboratory Findings ==
Based upon the history and physical, a standard evaluation might include:
 
Common high yield tests:
* [[Complete blood count]] ([[CBC]]): to rule out [[anemia]]
* [[Thyroid stimulating hormone]] ([[TSH]])
* [[Blood urea nitrogen]] ([[BUN]]) / [[creatinine]]
 
Less frequent low yield tests:
* [[Erythrocyte sedimentation rate]] ([[ESR]]): to evaluate autoimmune causes
* [[Calcium]]: to rule out [[hypocalcemia]]
* [[Magnesium]]: to rule out [[hypomagnesemia]]
* [[Rheumatoid factor]]
* [[Antinuclear antibody]] ([[ANA]])
* [[Glucose]]
* [[Pheochromocytoma]] screening
* [[Phosphorus]]: to rule out [[hypophosphatemia]]
* [[Blood culture]]s
 
=== Electrolyte and Biomarker Studies ===
* [[Electrolyte]]s should be periodically checked in the patient treated with a [[diuretic]] to avoid [[hypokalemia]].
* [[Brain Natriuretic Peptide]] ([[BNP]]) levels may provide insight into the ongoing magnitude of LV dysfunction.
 
=== Electrocardiogram ===
*The presence of [[q wave]]s suggest a prior [[MI]] to account for the enlargement.
*[[ST segment elevation]] would suggest either ongoing or resolving [[ST Elevation Myocardial Infarction]] or [[Myocarditis]] or [[Pericarditis]].
*The EKG may suggest signs of [[left atrial enlargement]], [[right atrial enlargement]] or [[right axis deviation]] which may point toward a specific diagnosis.
 
 
''Images shown below are courtesy of Professor Peter Anderson DVM PhD and published with permission. [http://www.peir.net © PEIR, University of Alabama at Birmingham, Department of Pathology]''
 
<div align="left">
<gallery heights="125" widths="175">
Image: RA enlargement EKG.jpg|Right atrial enlargement
Image: Biatrial enlargement EKG.jpg|Biatrial enlargement
</gallery>
</div>


=== Chest X Ray ===
=== Chest X Ray ===

Revision as of 14:05, 26 July 2011

Cardiomegaly Microchapters

Home

Patient Information

Overview

Historical Perspective

Pathophysiology

Causes

Differentiating Cardiomegaly from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

Chest X Ray

MRI

CT

Echocardiography or Ultrasound

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Cardiomegaly On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Cardiomegaly

CDC on Cardiomegaly

Cardiomegaly in the news

Blogs on Cardiomegaly

Directions to Hospitals Treating Cardiomegaly

Risk calculators and risk factors for Cardiomegaly

Template:DiseaseDisorder infobox

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor in Chief: Cafer Zorkun, M.D., Ph.D. [2]

Overview

Pathophysiology

Epidemiology and demographics

Risk factors

Screening

Natural History, Complications & Prognosis

Causes

Differential diagnosis of cardiomegaly

Diagnosis

History and Symptoms | Physical examination | Lab tests | Electrocardiogram |

Chest X Ray

  • Cardiomgaly is traditionally defined as an increase in the cardiothoracic ratio to be > 0.5 on a PA film. To calculate the thoracic ratio, the width of the cardiac silhouette is divided by the width of the entire thoracic cage.
  • If the heart is viewed on an AP film, the heart can appear to be artificially enlarged because the X ray beam moves from anterior to posterior direction and therefore the heart which lies anterior is magnified.
    • Postero Anterior (PA) Projection: adult heart is 12 cm from base to apex and 8-9 cm in transverse direction
    • Lateral Projection: The adult heart is 6 cm in the Antero Posterior (AP) direction

X-ray findings for left ventricular enlargement

  • Left heart border is displaced leftward, inferiorly, or posteriorly.
  • Rounding of the cardiac apex
Cardiomegaly.
Image courtesy of C. Michael Gibson MS. MD


Cardiomegaly in a patients after mitral valve replacement. AP view. Image courtesy of RadsWiki


Cardiomegaly in a patients after mitral valve replacement. Lateral view. Image courtesy of RadsWiki.


X-ray findings for left atrial enlargement

  • Double density sign: Occur when the right side of the left atrium pushes into the adjacent lung.
  • Convex left atria appendage: usually reflect prior rheumatic heart disease
  • Splaying of the carina
  • Posterior displacement of the left main stem bronchus on lateral radiograph
  • Superior displacement of the left main stem bronchus on frontal view
  • Posterior displacement of a barium filled esophagus
Double density sign


Double density sign


X-ray findings for right ventricular enlargement

  • Frontal view
  • Rounded left heart border
  • Uplifted apex
  • Lateral view
  • Filling of the retrosternal space
  • Rotation of the heart posteriorly

X-ray findings for right atrial enlargement

  • On a frontal view, the right atrium is visible because of its interface with the right middle lobe.
  • Subtle and moderate right atrial enlargement is not accurately determined on plain films because there is normal variability in the shape of the right atrium.

Echocardiography or Ultrasound

  • Echocardiogram recommended for those patients presenting suspected valvular disease, chamber size, ventricular function, and wall motion abnormalities

Other Diagnostic Studies

Pathological Findings

Image courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology

Right ventricular enlargement due to a patent ductus arteriosus in a patient with hyaline membrane disease


Treatment

Pharmacotherapy

Acute Pharmacotherapies

Chronic Pharmacotherapies

A combination of diuretics and angiotensin converting enzyme (ACE) inhibition is currently the standard of care. Digoxin may reduce the frequency of rehospitalization, but does not improve mortality.

Surgery and Device Based Therapy

Transplantation

Future or Investigational Therapies

Mechanical strategies currently under investigation include:

  1. Development of devices to reduce the size of the heart
  2. Development of a device to exclude that portion of the apex where clots may form.

Pathological Findings

Image courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology

Biventricular Hypertrophy


Biventricular Hypertrophy


Gross excellent example of concentric left ventricular hypertrophy


Left Ventricular Hypertrophy: Gross natural color anterior view intact heart showing disproportionate size of left ventricle by its inferior extent much below the right ventricle apex (quite good example)


Myocardial Infarct: Gross natural color apical section showing large left ventricle infarct and right ventricular hypertrophy


Right ventricular hypertrophy


References


Template:WikiDoc Sources

Retrieved from "https://www.wikidoc.org/index.php?title=Cardiomegaly&oldid=579110"