Differential Diagnosis of Cardiovascular Diseases

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Cardiovascular diseases encompass a wide range of disorders affecting the heart and blood vessels. The following is a categorized list of common CVDs along with their clinical features for systematic diagnosis.



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1. Coronary Artery Disease (CAD)

Examples:

Stable Angina

Acute Coronary Syndrome (Unstable Angina, NSTEMI, STEMI)


Clinical Features:

Retrosternal chest pain, often radiating to the left arm, neck, jaw, or back.

Pain triggered by exertion or emotional stress and relieved by rest (stable angina).

Dyspnea, nausea, diaphoresis, and palpitations during acute events.

Elevated cardiac biomarkers (troponin, CK-MB) in myocardial infarction.

ECG changes: ST-segment elevation/depression or T-wave inversion.



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2. Heart Failure

Examples:

Left-Sided Heart Failure

Right-Sided Heart Failure

Congestive Heart Failure


Clinical Features:

Dyspnea on exertion or at rest.

Orthopnea (difficulty breathing when lying flat).

Paroxysmal nocturnal dyspnea (PND).

Peripheral edema, ascites (right-sided failure).

Fatigue and exercise intolerance.

Elevated jugular venous pressure (JVP).

Pulmonary crackles (left-sided failure).



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3. Arrhythmias

Examples:

Atrial Fibrillation

Ventricular Tachycardia

Bradyarrhythmias (e.g., Complete Heart Block)


Clinical Features:

Palpitations or irregular heartbeat.

Syncope or presyncope.

Fatigue and dizziness.

ECG findings: Irregular RR intervals (AF), wide QRS (VT), absent P-waves (heart block).



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4. Valvular Heart Diseases

Examples:

Mitral Stenosis/Regurgitation

Aortic Stenosis/Regurgitation

Tricuspid or Pulmonary Valve Disorders


Clinical Features:

Murmurs: Ejection systolic (AS), mid-diastolic (MS), holosystolic (MR).

Fatigue, dyspnea, and syncope (AS).

Pulmonary hypertension signs (MS).

Heart failure symptoms in advanced stages.



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5. Pericardial Diseases

Examples:

Pericarditis

Pericardial Effusion

Cardiac Tamponade


Clinical Features:

Sharp, pleuritic chest pain relieved by sitting forward.

Pericardial friction rub on auscultation (pericarditis).

Pulsus paradoxus and muffled heart sounds (tamponade).

ECG: Diffuse ST-elevation (pericarditis) or low voltage QRS (effusion).



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6. Cardiomyopathies

Examples:

Hypertrophic Cardiomyopathy (HCM)

Dilated Cardiomyopathy (DCM)

Restrictive Cardiomyopathy (RCM)


Clinical Features:

Exertional dyspnea and syncope (HCM).

Signs of heart failure (DCM).

Reduced ventricular compliance (RCM).

Sudden cardiac death risk in young athletes (HCM).



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7. Congenital Heart Diseases

Examples:

Atrial Septal Defect (ASD)

Ventricular Septal Defect (VSD)

Tetralogy of Fallot


Clinical Features:

Cyanosis, especially in right-to-left shunts.

Failure to thrive and recurrent respiratory infections in infants.

Murmurs (e.g., systolic murmur in ASD or VSD).

Clubbing and squatting position in Tetralogy of Fallot.



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8. Hypertension-Related Heart Diseases

Examples:

Left Ventricular Hypertrophy (LVH)

Hypertensive Emergency/Encephalopathy


Clinical Features:

Persistent high blood pressure (>140/90 mmHg).

Headache, visual disturbances (hypertensive emergency).

Left ventricular heave and S4 gallop in LVH.

Target organ damage: retinopathy, nephropathy, and stroke.



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9. Vascular Diseases

Examples:

Aortic Dissection

Peripheral Artery Disease (PAD)

Deep Vein Thrombosis (DVT)


Clinical Features:

Sudden tearing chest/back pain, hypotension (aortic dissection).

Intermittent claudication and weak peripheral pulses (PAD).

Calf pain (Homan’s sign), swelling, and erythema (DVT).



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10. Infective and Inflammatory Conditions

Examples:

Infective Endocarditis

Rheumatic Heart Disease


Clinical Features:

Fever, new or changing murmurs (infective endocarditis).

Osler nodes, Janeway lesions, and Roth spots.

Migratory arthritis, erythema marginatum (rheumatic heart disease).

Post-streptococcal pharyngitis history in rheumatic fever.



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Approach to Diagnosis

1. History and Symptoms: Chest pain, dyspnea, palpitations, syncope, and edema.


2. Physical Examination: Heart sounds, murmurs, JVP, peripheral pulses, and signs of cyanosis.


3. Investigations:

ECG: Detect arrhythmias, ischemia, and structural changes.

Echocardiogram: Assess valvular and myocardial function.

Cardiac Biomarkers: Troponin, CK-MB for myocardial infarction.

Chest X-ray: Pulmonary congestion and cardiomegaly.

Blood Tests: CBC, lipid profile, renal function, and CRP.





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This differential diagnosis provides a structured guide to systematically approach and identify cardiovascular diseases based on clinical features.


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