Sandbox MC

Disease	Symptoms	Physical examination	Cardiac murmur	ECG	CXR	Echocardiography
Aortic valve stenosis	Exertional chest pain Dyspnea on exertion Decreased exercise tolerance Exertional syncope/pre-syncope	Narrow pulse pressure Normal to anacrotic carotid pulse (parvus et tardus) S1 usually normal A systolic ejection click may be audible afer S1 Single S2 If severe: paradoxical splitting of S2 S4 may be audible	Mid-to-late peaking systolic ejection murmur Best heard at right intercostal space Radiates equally to the carotid arteries Decseases with Valsalva maneuver	Left ventricular hypertrophy Left ventricular strain pattern	Left ventricualar hypertrophy If heart failure is present: pulmonary congestion Aortic valve calcification may be visible	Mild AS: Aortic Vmax 2.0-2.9 m/s or mean ΔP <20 mmHg Moderate AS: Aortic Vmax 3.0-3.9 m/s or mean ΔP 20-39 mmHg Severe AS: Aortic Vmax ≥ 4 m/s or mean ΔP ≥40 mmHg; AVA typically ≤ 1.0 cm2 (or AVAi ≤ 0.6 cm2/m2) Very severe AS: Aortic Vmax ≥ 5 m/s or mean ΔP ≥60 mmHg Ejection fraction (EF) may be normal or reduced
Aortic valve sclerosis without stenosis
Supvalvular stenosis
Supravalvular stenosis
Hypertrophic cardiomyopathy

constrictive cardiomyopathy should be differentiated from restrictive cardiomyopathy,

Differentiating restrictive cardiomyopathy from Other Diseases

Type of disease	History	Physical examination	Chest X-ray	ECG	2D echo	Doppler echo	CT	MRI	Catheterization hemodynamics	Biopsy
Restrictive cardiomyopathy	Systemic disease (e.g., sarcoidosis, hemochromatosis).	± Kussmaul sign S3 and S4 gallop, murmurs of mitral and tricuspid regurgitation	Atrial dilatation	Low QRS voltages (mainly amyloidosis), conduction disturbances, nonspecific ST abnormalities	± Wall and valvular thickening, sparkling myocardium	Decreased variation in mitral and/or tricuspid inflow E velocity, increased hepatic vein inspiratory diastolic flow reversal, presence of mitral and tricuspid regurgitation	Normal pericardium	Measurement of iron overload, various types of LGE (late gadolinium enhancement)	LVEDP – RVEDP ≥ 5 mmHg RVSP ≥ 55 mmHg RVEDP/RVSP ≤ 0.33	May reveal underlying cause.
Constrictive pericarditis	Prior history of pericarditis or conditions affecting the pericardium, such as uremia, HIV, TB, or radiation	Pericardial knock	Pericardial calcification	Nonspecific ST and T abnormalities, low QRS voltage (<50%)	± Pericardial thickening, respiratory ventricular septal shift.	Increased variation in mitral and/or tricuspid inflow E velocity, hepatic vein expiratory diastolic reversal ratio ≥ 0.79 medial e′/lateral e′ ≥ 0.91 (Annulus Reversus)	Thickened/calcified pericardium	Thickened pericardium	LVEDP – RVEDP < 5 mmHg RVSP < 55 mmHg RVEDP/RVSP > 0.33 Inspiratory decrease in RAP < 5 mmHg Systolic area index > 1.1 (Ref CP in the modern era) Left ventricular height of rapid filling wave > 7 mmHg	Normal myocardium