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__NOTOC__
__NOTOC__
[[Image:Home_logo1.png|right|250px|link=https://www.wikidoc.org/index.php/Xyz]]
Template:Atherosclerosis
{{CMG}}; {{AE}}
==Overview==
[Disease name] must be differentiated from other diseases that cause [clinical feature 1], [clinical feature 2], and [clinical feature 3], such as [differential dx1], [differential dx2], and [differential dx3].
OR
[Disease name] must be differentiated from [[differential dx1], [differential dx2], and [differential dx3].
==Differentiating [Disease name] from other Diseases==
[Disease name] must be differentiated from other diseases that cause [clinical feature 1], [clinical feature 2], and [clinical feature 3], such as [differential dx1], [differential dx2], and [differential dx3].
OR
[Disease name] must be differentiated from [differential dx1], [differential dx2], and [differential dx3].
OR
As [disease name] manifests in a variety of clinical forms, differentiation must be established in accordance with the particular subtype. [Subtype name 1] must be differentiated from other diseases that cause [clinical feature 1], such as [differential dx1] and [differential dx2]. In contrast, [subtype name 2] must be differentiated from other diseases that cause [clinical feature 2], such as [differential dx3] and [differential dx4].
===Differentiating [disease name] from other diseases on the basis of [symptom 1], [symptom 2], and [symptom 3]===
On the basis [symptom 1], [symptom 2], and [symptom 3], [disease name] must be differentiated from [disease 1], [disease 2], [disease 3], [disease 4], [disease 5], and [disease 6].<ref name="pmid32376308">{{cite journal| author=Zhao Q, Meng M, Kumar R, Wu Y, Huang J, Deng Y | display-authors=etal| title=Lymphopenia is associated with severe coronavirus disease 2019 (COVID-19) infections: A systemic review and meta-analysis. | journal=Int J Infect Dis | year= 2020 | volume= 96 | issue=  | pages= 131-135 | pmid=32376308 | doi=10.1016/j.ijid.2020.04.086 | pmc=7196544 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32376308  }}</ref>
{|
{|
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
! rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;|Diseases
! rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Diseases
| colspan="5" |'''Clinical manifestations'''
| colspan="3" |'''Clinical Findings'''
! colspan="7" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;|Para-clinical findings
! colspan="3" rowspan="2" |Diagnosis
| colspan="1" rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;|'''Gold standard'''
| colspan="1" rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Gold standard'''
! rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;|Additional findings
|-
|-
| colspan="2" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center; |'''Symptoms'''
| colspan="2" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center; " |'''History'''
! colspan="3" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;|Physical examination
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center; " | Physical examination
|-
|-
! colspan="3" style="background: #4479BA; color: #FFFFFF; text-align: center;|Lab Findings
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center; " | ECG
! colspan="3" style="background: #4479BA; color: #FFFFFF; text-align: center;|Imaging
! colspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Imaging
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;|Histopathology
|-
|-
! colspan="1" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;|Symptom 2
! colspan="1" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Etiology
! style="background: #4479BA; color: #FFFFFF; text-align: center;|Symptom 3
! colspan="1" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Signs & Symptoms
! style="background: #4479BA; color: #FFFFFF; text-align: center;|Physical exam 1
! colspan="1" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Murmur Type
! colspan="1" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;|Physical exam 2
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |CXR
! style="background: #4479BA; color: #FFFFFF; text-align: center;|Physical exam 3
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Echocardiogram
! style="background: #4479BA; color: #FFFFFF; text-align: center;|Lab 1
! style="background: #4479BA; color: #FFFFFF; text-align: center;|Lab 2
! style="background: #4479BA; color: #FFFFFF; text-align: center;|Lab 3
! style="background: #4479BA; color: #FFFFFF; text-align: center;|Imaging 1
! style="background: #4479BA; color: #FFFFFF; text-align: center;|Imaging 2
! style="background: #4479BA; color: #FFFFFF; text-align: center;|Imaging 3
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Differential Diagnosis 2
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Aortic Stenosis
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Age-related calcification in the elderly
* Bicuspid aortic valve in the young
** leads to early calcification of the valve
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Chest pain
* Dyspnea on exertion
* Palpitations
* Symptoms of heart failure
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
Systolic murmur
* crescendo-decrescendo murmur
** radiates to the carotids
** heard best at the base
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
'''[[Left ventricular hypertrophy]]''':
* Wide QRS complex (especially in leads V1-V6)
* ST depression in leads V5-V6
* Left axis deviation
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Enlarged left ventricle
* Enlarged left atrium and pulmonary artery in severe cases
* Calcification of the aortic valve
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Thickening and calcification of the aortic valve
* Left ventricular hypertrophy
| style="background: #F5F5F5; padding: 5px;" |[[Echocardiography|Echocardiogram]]
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Differential Diagnosis 3
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Aortic Regurgitation
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Aortic root dilatation
* Bicuspid aortic valve
* Endocarditis
* Rheumatic fever
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* [[Dyspnea on exertion]]
* [[Paroxysmal nocturnal dyspnea]]
* [[Orthopnea]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Diastolic murmur
** early diastolic decrescendo murmur
** Austin Flint murmur
*** apical diastolic rumbling <br />
* Maneuvers
** ↑ murmur intensity<br />
*** hand grip
*** rapid squatting
| style="background: #F5F5F5; padding: 5px;" |'''Left ventricular hypertrophy''':
*[[Wide QRS complex]] (especially in leads V1-V6)
* ST depression in leads V5-V6
* Left axis deviation
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Prominent aortic root/arch <span class="condensed-hidden"><span class="icon no-float icon-tooltip bubble" miamed-tooltip="" tooltip-delay="150" tooltip-hide-timeout="400" tooltip-content="Due%20to%20dilated%20%3Ca%20href%3D%22https%3A%2F%2Fwww.amboss.com%2Fus%2Fknowledge%2FThoracic_cavity%23xid%3DOp0IpS%26anker%3DZ0c76bb0a26183ea6951d377eda943ca2%22%20ng-href%3D%22%7B%7B%20linkLearningcard%28%27Op0IpS%27%2C%27Z0c76bb0a26183ea6951d377eda943ca2%27%29%3B%20%7D%7D%22%20class%3D%22autolink%22%20data-miamed-target%3D%22Op0IpS%22%20data-section-id%3D%22YCcnqe0%22%20data-phrasegroup-id%3D%22m_XVK00%22%20id%3D%2272a86722ba63a69ed2aa3179185f13a3%22%20data-source%3D%2272a86722ba63a69ed2aa3179185f13a3%22%3Eascending%20aorta%3C%2Fa%3E%0A"></span></span>
* Enlarged cardiac silhouette
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* aortic regurgitation
| style="background: #F5F5F5; padding: 5px;" |
* Dilated left ventricle and aorta
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |[[Echocardiography|Echocardiogram]]
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
!Diseases
! colspan="1" rowspan="1" |Symptom 2
!Symptom 3
!Physical exam 1
! colspan="1" rowspan="1" |Physical exam 2
!Physical exam 3
!Lab 1
!Lab 2
!Lab 3
!Imaging 1
!Imaging 2
!Imaging 3
!Histopathology
|'''Gold standard'''
!Additional findings
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Differential Diagnosis 4
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Mitral Stenosis
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Rheumatic fever
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* [[Dyspnea on exertion]]
* [[Paroxysmal nocturnal dyspnea]]
* [[Orthopnea]]
* New onset [[atrial fibrillation]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
Diastolic murmur
* open snap (OS) and delayed rumbling mid-to-late diastolic murmur
** the time between A2 and OS is inversely correlated with severity
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* [[P mitrale]]
* [[Atrial fibrillation]]: No P waves and irregularly irregular rhythm
* [[Right axis deviation]]
* Right ventricular hypertropy: Dominant R wave in V1 and V2
<br />
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* 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
* Splaying of [[Carina|subcarinal angle]] (>120 degrees)
* Calcification of [[mitral valve]]
* [[Kerley B lines]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Reduced valve leaflet mobility
* Valve calcification
* Doming of mitral valve
* Valve thickening
* Enlargement of left atrium
| style="background: #F5F5F5; padding: 5px;" |[[Echocardiography|Echocardiogram]]
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Differential Diagnosis 5
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Mitral Regurgitation
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Differential Diagnosis 6
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Rheumatic fever
* Endocarditis
* Post-myocardial infarction
** rupture of the chordae or papillary muscles  
* Left ventricular dilatation
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* [[Palpitations]]
* Symptoms of heart failure in severe cases
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Holosystolic murmur
** high-pitched and radiates towards the axilla
** heard best at the apex
* Maneuvers
** ↑ murmur intensity<br />
*** hand grip
*** rapid squatting
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* [[P mitrale]] in lead II
* Increased QRS voltage
* [[Right axis deviation]]
* [[Atrial fibrillation]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
'''Acute MR'''
* [[Kerley B lines]]
* No enlargement of cardiac silhouette
'''Chronic MR'''
* Enlarged cardiac silhouette
* Straightening of left heart border
* Splaying of subcarinal angle
* Calcification of mitral annulus
* Double right heart border
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Enlargement of left atrium and ventricle
* Identify valve abnormality
* Valve calcification
* Severity of regurgitation
| style="background: #F5F5F5; padding: 5px;" |[[Echocardiography|Echocardiogram]]
|}
|}



Latest revision as of 17:09, 27 July 2020

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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