Right ventricular outflow tract obstruction differential diagnosis
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]
Associate Editor-in-Chief: Keri Shafer, M.D. [3]
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Differential Diagnosis
1. ASD: 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 VSD: Amyl nitrate increases venous return and increases the murmur of PS, in VSD the murmur becomes softer.
3. Mild left-sided outflow obstruction: With valsalva the murmur of AS becomes softer after about 5 beats, with PS 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.