Differentials
Cardiac tumours
SIGNS / SYMPTOMS
There are no specific differentiating signs/symptoms.
INVESTIGATIONS
Echocardiogram will often show tumours and differentiate cause.
Systemic lupus erythematosus (SLE)
SIGNS / SYMPTOMS
Malar rash, arthritis/arthralgias, pancytopenia, photosensitivity, renal involvement, alopecia, or Raynaud's phenomenon.
INVESTIGATIONS
Antinuclear antibody, anti-dsDNA or anti-Sm antibodies may be positive in SLE.
Constrictive pericarditis (CP)
SIGNS / SYMPTOMS
Usually have a previous history of tuberculosis, pericarditis, cardiac surgery, mantle radiation, chest trauma, or connective tissue disease. Murmurs are rare with CP and jugular venous pulsations are less prominent.
INVESTIGATIONS
Calcification of pericardium sometimes seen on chest x-ray.
Echocardiogram shows only mildly enlarged atrium and normal tricuspid valve without a gradient.
Cardiac catheterisation reveals absence of tricuspid valve gradient and classic haemodynamic findings of CP.
Restrictive cardiomyopathy
SIGNS / SYMPTOMS
History is usually unremarkable. Systolic murmurs of mitral and tricuspid regurgitation are most common. Diastolic murmurs are less common. Jugular venous pulsations can be prominent.
INVESTIGATIONS
Echocardiogram shows severe bi-atrial enlargement in the absence of significant AV valve gradient. Valve can sometimes be thickened, but shortened chordae and commissural fusion are rarely discovered.
Cardiac catheterisation reveals classic findings of restrictive cardiomyopathy without tricuspid valve gradient.
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