Pulmonic regurgitation differential diagnosis: Difference between revisions
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[[Image:Home_logo1.png|right|250px|link=http://www.wikidoc.org/index.php/Pulmonic_regurgitation]] | |||
{{CMG}}, {{AE}} {{AKI}}, {{AA}} | {{CMG}}, {{AE}} {{AKI}}, {{AA}} | ||
==Overview== | ==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]]. | [[PR|Pulmonic regurgitation]] (PR) must be differentiated from other [[diseases]] that cause blowing [[Diastolic heart murmur|decrescendo murmur]] such as [[aortic regurgitation]]. 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]]. | ||
==Differential diagnosis of pulmonic regurgitation== | ==Differential diagnosis of pulmonic regurgitation== | ||
The diseases which may present with overlapping symptoms as [[pulmonic regurgitation]] may include the following: | [[PR|Pulmonic regurgitation]] (PR) must be differentiated from other [[diseases]] that cause blowing [[Diastolic heart murmur|decrescendo murmur]] such as [[aortic regurgitation]]. The [[diseases]] which may present with overlapping [[symptoms]] as [[pulmonic regurgitation]] may include the following: | ||
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| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Tricuspid Regurgitation]] causing [[right vetricular]] enlargement''' | | 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> | *[[Murmur patterns#Holosystolic (Pansystolic) Murmur|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|"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> | ||
|- | |- | ||
| 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 [[Congenital heart disease classification|acyanotic congenital disease]] such as [[ASD]] | ||
*Fixed splitting of [[S2]] is present | *Fixed splitting of [[S2]] is present | ||
|- | |- | ||
| style="padding: 5px 5px; background: #DCDCDC;" | ''' | | style="padding: 5px 5px; background: #DCDCDC;" | '''Arrhythmogenic 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" | *[[EKG]] shows negative [[T wave|"T" wave]]s and [[epsilon waves]] with selective "[[S wave|"S" wave]] delay in V1 to V3 | ||
*[[RV]] is dilated and hypokinetic on [[echocardiography]] | *[[RV]] is dilated and hypokinetic on [[echocardiography]] | ||
*[[Holter monitoring]] helps to diagnose hyperkinetic [[ventricular arrythmias]] | *[[Holter monitoring]] helps to [[diagnose]] hyperkinetic [[ventricular arrythmias]] | ||
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* [[Marfan syndrome]] | * [[Marfan syndrome]] | ||
* [[Syphilis | Syphilis infection]] | * [[Syphilis | Syphilis infection]] | ||
* Trauma from withdrawing a Swan-Ganz catheter with the balloon inflated | * Trauma from withdrawing a Swan-Ganz catheter with the balloon inflated | ||
* Following [[valvuloplasty]] of [[pulmonary stenosis]] | * Following [[valvuloplasty]] of [[pulmonary stenosis]] | ||
* Absence of the pulmonic valve | * Absence of the pulmonic valve | ||
Latest revision as of 21:57, 6 August 2020
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
Pulmonic regurgitation (PR) must be differentiated from other diseases that cause blowing decrescendo murmur such as aortic regurgitation. 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.
Differential diagnosis of pulmonic regurgitation
Pulmonic regurgitation (PR) must be differentiated from other diseases that cause blowing decrescendo murmur such as aortic regurgitation. The diseases which may present with overlapping symptoms as pulmonic regurgitation may include the following:
| Disease | Findings |
|---|---|
| Aortic Regurgitation |
|
| Tricuspid Regurgitation causing right vetricular enlargement |
|
| Left to Right Shunt causing RV enlargement |
|
| Arrhythmogenic Right Ventricular Cardiomyopathy |
|
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
- ↑ Template:Citejournal
- ↑ 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.
- ↑ 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.
- ↑ 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.