[Skill Modules
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Heart Sounds & Murmurs
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Differential Dx
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Differential Diagnosis: Heart
Sounds & Murmurs
Differential Diagnosis of Clinical Symptoms
Dyspnea
- Heart Failure
- Ischemic heart disease (anginal equivalent)
- Pulmonary Embolism
- Lung Disease including COPD & Asthma
- Severe Anemia
| New York Heart Association Classification for Heart Failure |
| Class I |
Dyspnea only with vigorous exertion |
| Class II |
Dyspnea with moderate exertion
|
| Class III |
Dyspnea with mild exertion, may have mild dyspnea at rest |
| Class IV |
Significant dyspnea at rest |
Chest pain at rest
- Myocardial infarction
- Unstable angina
- Dissecting aortic aneurysm
- Esophagitis
- Pulmonary Embolism
- Pneumothorax
- Pericarditis
- Pleuritic pain
- Musculoskeletal pain including costochondritis
- Herpes zoster
Chest pain on exertion
- Angina related to atherosclerosis
- Coronary vasospasm with normal coronary arteries
- Aortic stenosis
- Hypertrophic cardiomyopathy
- Musculoskeletal
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Differential Diagnosis of Systolic Murmurs
Systolic Ejection
- Benign
- Innocent systolic murmur (vibratory)
-
Flow murmurs
- Hemodynamic effect (i.e., fever, hyperthyroidism, severe anemia)
- Athlete's heart
- Atrial septal defect (incidental)
- Pathologic
- Aortic stenosis
- Pulmonary stenosis
- Hypertrophic cardiomyopathy
- Atrial septal defect
- Pansystolic
- Tricuspid reflux
- Mitral reflux
- Ventricular septal
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Differential Diagnosis of Pericardial Friction Rub
Caused by inflammation of the pericardial sac with or without fluid.
Pericarditis
-
Infectious
- viral,
- bacterial
- tuberculous
- fungal
-
Noninfectious
- myocardial infarction
- uremia
- malignancy
- myxedema
- trauma
- open-heart surgery
-
Autoimmune
- rheumatic fever
- drug induced (pracainamide)
- post-myocardial infarction (Dressler's syndrome)
- collagen vascular disease
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