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|- 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
|l
| colspan="3" |'''Clinical Findings'''
| colspan="5" |'''Clinical manifestations'''
! colspan="3" rowspan="2" |Diagnosis
! colspan="7" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Para-clinical findings
| 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
|-
|-
|m
| colspan="2" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center; " |'''History'''
| 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
|-
|-
!n
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center; " | ECG
! colspan="3" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Lab Findings
! colspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Imaging
! colspan="3" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Imaging
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Histopathology
|-
|-
!o
! colspan="1" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Etiology
! colspan="1" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Symptom 1
! colspan="1" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Signs & Symptoms
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Symptom 2
! colspan="1" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Murmur Type
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Physical exam 1
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |CXR
! colspan="1" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Physical exam 2
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Echocardiogram
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Physical exam 3
! 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;" |Aortic Stenosis
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Aortic Stenosis
|
| style="background: #F5F5F5; padding: 5px;" |Orthopnea
| style="background: #F5F5F5; padding: 5px;" |Paroxysmal Nocturnal Dysnea
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
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| style="background: #F5F5F5; padding: 5px;" |
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* 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;" |Aortic Regurgitation
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Aortic Regurgitation
|
| style="background: #F5F5F5; padding: 5px;" |Orthopnea
| style="background: #F5F5F5; padding: 5px;" |Paroxysmal Nocturnal Dysnea
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
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* 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;" |
* aortic regurgitation
* Dilated left ventricle and aorta
| style="background: #F5F5F5; padding: 5px;" |[[Echocardiography|Echocardiogram]]
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Mitral Stenosis
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Mitral Stenosis
|
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
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| style="background: #F5F5F5; padding: 5px;" |
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| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
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* 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;" |Mitral Regurgitation
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Mitral Regurgitation
|
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
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| 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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