CARDIOMEGALY

CARDIOMEGALY: Excerpt from Algorithmic Diagnosis of Symptoms and Signs

Ask the following questions:

1. Is there a murmur? Cardiomegaly with cardiac murmurs suggests valvular disease, but it also suggests congestive heart failure and advanced myocardiopathies. One should also be sure that the murmur is not a pericardial friction rub.
2. Is there fever? Fever with cardiomegaly should suggest rheumatic heart disease and bacterial endocarditis. However, it may also suggest an acute myocarditis or acute pericarditis.
3. Is there chest pain? Cardiomegaly with chest pain would certainly suggest a myocardial infarction, but it also may suggest an acute pericarditis.
4. Is there hepatomegaly? Cardiomegaly and hepatomegaly suggest congestive heart failure. Hepatomegaly also may suggest one of the systemic diseases that causes a myocardiopathy such as amyloidosis.
5. Is there edema? The presence of peripheral edema would suggest congestive heart failure, and if it is nonpitting, it would suggest myxedema.
6. Is there hypertension? Cardiomegaly with hypertension would suggest that the cardiomegaly is due to left ventricular enlargement from the chronic hypertension.
7. Is there cyanosis? Cardiomegaly with cyanosis, particularly if there is an associated murmur, suggests congenital heart disease of the cyanotic type.

DIAGNOSTIC WORKUP

A CBC, sedimentation rate, ANA, chemistry panel, VDRL test, thyroid profile, EKG, and chest x-ray should be done on all patients. An echocardiogram will be helpful in diagnosing valvular disease, myocardiopathies, congestive heart failure, and pericardial effusion. If congestive heart failure is suspected, venous pressure and circulation time can be measured, and one should do pulmonary function studies. If there is fever, then one would want to do a streptozyme test, ASO titer, and serial blood cultures. If there is hypertension, a hypertensive workup may be indicated . Patients with cyanosis need a workup for congenital heart disease, which will probably include cardiac catheterization and angiocardiography.

Most prudent physicians will refer the patient with cardiomegaly to a cardiologist before pursuing this extensive diagnostic workup.

Book Source Details

• Book Title: Algorithmic Diagnosis of Symptoms and Signs
• Author(s): R. Douglas Collins
• Year of Publication: 2003
• Copyright Details: Algorithmic Diagnosis of Symptoms and Signs, Copyright © 2003 Lippincott Williams & Wilkins.

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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.

More About This Book: Title: Algorithmic Diagnosis of Symptoms and Signs Authors: R. Douglas Collins Publisher: Lippincott Williams & Wilkins Copyright: 2003 ISBN: 0-7817-3805-9

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