a referred male corporal, 24yrs

from the NEUROLOGICAL OPD

ASYMPTOMATIC; Hypertensive
parents and siblings are fine
weight-lifter from EAST-KALIMANTAN
athletic,
very good physical posture
construction
of a diagnosis
benav_2007@yahoo.com
31 (thirty-one) projections
6(six) minutes
constructing
a diagnosis
IMCU PHCA 02:37 AM 1982 Sunday
 05:47AM CST
01:30PM CST

SLEH
TCH Methodist
THI
M.D.Anderson Baylor
Veterans
 male corporal, 24yrs
referral from the NEUROLOGICAL OPD
ASYMPTOMATIC; Hypertensive
weight-lifter
athletic, vey good physical posture

ABP 240/100mmHg
TRUST
AND
VERIFY
Ronald Reagan
P lazim, (q), positive R (S) agak TINGGI

T lazim
Asc.Ao LEBAR, PuV/MPA/RPA/LPA semua lazim
 male corporal, 24yrs
referral from the NEUROLOGICAL OPD
ASYMPTOMATIC; Hypertensive
weight-lifter
athletic, vey good physical posture

ABP 240/100mmHg
240/95 M,24Y 230/100
neurological OPD
ASY;hypertensive U-ABP/L-ABP dyscrepancy
athletic, ABP240/100mmHg
humeral
palpable intercostal thrill
intercostal (2nd-5th)murmur humeral

HgB 21%; Hct 41%; n.WBC diff.count

R
femoral
n.b.chem.; n.urinalysis
n.PA&lat CXR; n.ECG; Lvh on echo
CXR shows marked prox.desc.Ao as
well as POROTIC proximal R-6thrib
LVH on 12-leads ECG
Lfemoral
Ao and MPA on echo.

100/50 90/50
 Differential diagnosis
of Congenital Heart Diseases
V(entricular) SVSD(eptal) D(efect)(31.3%)
P(ulmonary) PS (valve) S(tenosis) (13.5%)
2 o(secundum) o
A(trial)
2 ASDS(eptal) D(efect)(6.1%)
P(atent) DPDA
(uctus) A(rteriosus) (5.5%)
Ao(rtic) coarct(ation) (5.5%)
T(etralogy)TOFO(f) F(allot) (3.7%)
o
1 o(primum)A(trial)1SASD(eptal)(3.7%)
D(efect)
diagnosing
diagnozing

is NOT
guessing
by eliminating
constructing
other possibilities
a diagnosis
in the
differential diagnosis
 Differential diagnosis
Congenital Heart Disease

Cyanotic
Acyanotic
 Differential diagnosis of CHD
Cyanotic Acyanotic
PBF N/s PBF w/o shunt with shunt
L R At-At
A Vt-Vt Ao-RA Ao-MPA multi
Tric.A
TGA
AS PS ASD+PS ECD+PS coro.AVf PDA Comp.ECD
TA TBA TAVPC+lPHPN DORV1 rSVC AoPADef VSD+PDA
(DORV w/s.p..VSD) Ao Coarct. PR
TAVPC pAVPC iVSD+AR PA+LCA Tric.A AVSD
Ebstein MR low PHPN Lutembacher
SV
SVC-LA Ebstein (ASD+MS)
CA FE
1V
TOF w/PA
TOF
C3A
Tric.A
PS
ASD w/LIVC
DORV e.t.c.
Ao-PA
(DOM.LV,
DOM.RV w/NPAP,
DOM.RV w/PHPN)
N/Nn VV
(PA-AVF,CAVA-LA1)
 Differential diagnosis of CHD

Acyanotic A

w/o shunt with shunt

L R
AA VV Ao-RA Ao-MPA multi
AS PS ASD+PS ECD+PS
coro.AVf PDA Comp.ECD
TAVPC+lPHPN DORV1
Ao Coarct. PR pAVPC iVSD+AR rSVC AoPADef VSD+PDA
MR low PHPN Lutembacher
F.E.
PA+LCA Tric.A AVSD
Ebstein (ASD+MS)

C3A
Differential diagnosis of CHD

Acyanotic A
w/o shunt
Left side Right side
Aortic stenosis
Aotic coarctation Pulmonary stenosis
Mitral regurgitation Pulmonary regurgitatiom
Fibro elastosis primary PHPN (low)
Cor triatriatum Ebstein (severe TR)
Differential diagnosis of CHD
Acyanotic
w/o shunt A

Left side
congenital Aortic stenosis
Aortic coarctation
congenital Mitral regurgitation
Fibroellastosis
Cor triatriatum
240/95 M,24Y 230/100
neurological OPD
ASY;hypertensive U-ABP/L-ABP dyscrepancy
athletic, ABP240/100mmHg
humeral
palpable intercostal thrill
intercostal (1st-5th)murmur humeral

HgB 21%; Hct 41%; n.WBC diff.count

R
femoral
n.b.chem.; n.urinalysis
n.PA&lat CXR; n.ECG; Lvh on echo
CXR shows marked prox desc.Ao as
well as porotic proxmal R-6thrib
LVH on 12-leads ECG
Lfemoral
Ao and MPA on echo.

100/50 90/50
 Diagnosis
congenital heart disease
Aortic coarctation
 Dx
CHD
aortic
Hypertension
coarctation
pre Sx Tx
amlodipine 5mg oral OD
clopidrogel 75mg oral OD
losartan 50mg oral OD
20-12-1978