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Diseases Clinical Findings Diagnosis Gold standard
History Physical examination
ECG Imaging
Etiology Signs & Symptoms Murmur Type CXR Echocardiogram
Aortic Stenosis
  • Age-related calcification in the elderly
  • Bicuspid aortic valve in the young
    • leads to early calcification of the valve
  • Chest pain
  • Dyspnea on exertion
  • Palpitations
  • Symptoms of heart failure


Systolic murmur

  • crescendo-decrescendo murmur
    • radiates to the carotids
    • heard best at the base


Left ventricular hypertrophy:

  • Wide QRS complex (especially in leads V1-V6)
  • ST depression in leads V5-V6
  • Left axis deviation
  • Enlarged left ventricle
  • Enlarged left atrium and pulmonary artery in severe cases
  • Calcification of the aortic valve
  • Thickening and calcification of the aortic valve
  • Left ventricular hypertrophy
Echocardiogram
Aortic Regurgitation
  • Aortic root dilatation
  • Bicuspid aortic valve
  • Endocarditis
  • Rheumatic fever
  • Diastolic murmur
    • early diastolic decrescendo murmur
    • Austin Flint murmur
      • apical diastolic rumbling
  • Maneuvers
    • ↑ murmur intensity
      • hand grip
      • rapid squatting
Left ventricular hypertrophy:
  • Wide QRS complex (especially in leads V1-V6)
  • ST depression in leads V5-V6
  • Left axis deviation
  • Prominent aortic root/arch
  • Enlarged cardiac silhouette
  • aortic regurgitation
  • Dilated left ventricle and aorta
Echocardiogram
Mitral Stenosis
  • Rheumatic fever


Diastolic murmur

  • open snap (OS) and delayed rumbling mid-to-late diastolic murmur
    • the time between A2 and OS is inversely correlated with severity
  • Right ventricular hypertropy: Dominant R wave in V1 and V2


  • Straightening of the left border of the heart suggestive of enlargement of the left atrium
  • Double right heart border (Enlarged left atrium and normal right atrium)
  • Prominent left atrial appendage
  • Reduced valve leaflet mobility
  • Valve calcification
  • Doming of mitral valve
  • Valve thickening
  • Enlargement of left atrium
Echocardiogram
Mitral Regurgitation
  • Rheumatic fever
  • Endocarditis
  • Post-myocardial infarction
    • rupture of the chordae or papillary muscles  
  • Left ventricular dilatation
  • Symptoms of heart failure in severe cases
  • Holosystolic murmur
    • high-pitched and radiates towards the axilla
    • heard best at the apex
  • Maneuvers
    • ↑ murmur intensity
      • hand grip
      • rapid squatting


Acute MR

Chronic MR

  • Enlarged cardiac silhouette
  • Straightening of left heart border
  • Splaying of subcarinal angle
  • Calcification of mitral annulus
  • Double right heart border
  • Enlargement of left atrium and ventricle
  • Identify valve abnormality
  • Valve calcification
  • Severity of regurgitation
Echocardiogram

References

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