By Donald N. Ross B. Sc., M. B., CH. B., F. R. C. S. (auth.)
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Extra info for A Surgeons’ Guide to Cardiac Diagnosis: Part II The Clinical Picture
Chest radiography demonstrates the large heart, the enlargement affecting mainly the right atrium, right ventricle and pulmonary artery. The aorta is small. As in allleft-to-right shunts there is a pleonaemic vascular pattern to the lungs. The electrocardiograph shows a pattern of right ventricular hypertrophy with a bifid wave pattern in the V 1 chest lead (fig. 29). Confirmation of the diagnosis is by cardiac catheterisation either by passing a catheter across the defect and by the demonstration of a shunt of oxygenated blood into the right atrium.
If the cardiac output is measured at the same time, usually by a dye dilution technique, the valve orifice can be calculated. Supra-aortic and sub-aortic stenosis can be confirmed by means of retrograde aortography. Differential Diagnosis Mitral regurgitation may have to be distinguished in cases with a systolic murmur. In this condition the pulse has a sharper upstroke and the left ventricular thrust is hyperdynamic in quality. The systolic murmur is best heard out towards the axilla and unlike the delayed ejection type of murmur of aortic stenosis, the murmur is pansystolic and coincident with the first sound.
Clinical Features Symptoms may not arise until adult life when the condition is likely to be confused with acquired aortic stenosis secondary to rheumatic fever. Alternatively Clinical Features 35 a congenitally stenosed but otherwise adequate valve may only become calcified and rigid in adult life and it will then constitute an obstruction. The classical symptoms are breathlessness, syncope and angina. The breathlessness comes about as the result of congestion of the lungs and is thought to represent a 'failing' left ventricle.