Pulmonic regurgitation history and symptoms: Difference between revisions
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==Overview== | ==Overview== | ||
==History == | ==History and Symptoms== | ||
Clinical presentation of pulmonary regurgitation varies on the severity of the regurgitation and the right ventricular function.<ref name="pmid19038677">{{cite journal| author=Warnes CA, Williams RG, Bashore TM, Child JS, Connolly HM, Dearani JA et al.| title=ACC/AHA 2008 guidelines for the management of adults with congenital heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Develop Guidelines on the Management of Adults With Congenital Heart Disease). Developed in Collaboration With the American Society of Echocardiography, Heart Rhythm Society, International Society for Adult Congenital Heart Disease, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. | journal=J Am Coll Cardiol | year= 2008 | volume= 52 | issue= 23 | pages= e143-263 | pmid=19038677 | doi=10.1016/j.jacc.2008.10.001 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19038677 }} </ref><ref name="pmid6207619">{{cite journal| author=Shimazaki Y, Blackstone EH, Kirklin JW| title=The natural history of isolated congenital pulmonary valve incompetence: surgical implications. | journal=Thorac Cardiovasc Surg | year= 1984 | volume= 32 | issue= 4 | pages= 257-9 | pmid=6207619 | doi=10.1055/s-2007-1023399 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6207619 }} </ref> | |||
*Isolated pulmonary regurgitation is usually asymptomatic and is an incidental finding on 2D echo even when the regurgitation is severe. | |||
*Patients with chronic PR develop right heart failure and present with the following symptoms: | |||
**Intitial symptom of chronic PR is functional limitation of physical activity | |||
**[[Ankle edema]] or [[swelling of the feet]] and legs | |||
**[[Dyspnea|Dyspnea on exertion]] | |||
**[[Fatigue]] | |||
**[[Hemoptysis]] or frothy sputum | |||
**[[cough|Nocturnal cough]] | |||
**[[Palpitation]]s or [[extra heart beats]] | |||
*Patients with arrythmias present with palpitations, dizziness, or an episode of syncope<ref name="pmid15640261">{{cite journal| author=Bouzas B, Kilner PJ, Gatzoulis MA| title=Pulmonary regurgitation: not a benign lesion. | journal=Eur Heart J | year= 2005 | volume= 26 | issue= 5 | pages= 433-9 | pmid=15640261 | doi=10.1093/eurheartj/ehi091 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15640261 }} </ref><ref name="pmid7421291">{{cite journal| author=Wessel HU, Cunningham WJ, Paul MH, Bastanier CK, Muster AJ, Idriss FS| title=Exercise performance in tetralogy of Fallot after intracardiac repair. | journal=J Thorac Cardiovasc Surg | year= 1980 | volume= 80 | issue= 4 | pages= 582-93 | pmid=7421291 | doi= | pmc= | url= }} </ref> At this stage, research suggests that diagnostic measures such as [[exercise testing]] may indicate varying levels of exercise intolerance.<ref name="pmid15640261">{{cite journal| author=Bouzas B, Kilner PJ, Gatzoulis MA| title=Pulmonary regurgitation: not a benign lesion. | journal=Eur Heart J | year= 2005 | volume= 26 | issue= 5 | pages= 433-9 | pmid=15640261 | doi=10.1093/eurheartj/ehi091 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15640261 }} </ref><ref name="pmid1622697">{{cite journal| author=Carvalho JS, Shinebourne EA, Busst C, Rigby ML, Redington AN| title=Exercise capacity after complete repair of tetralogy of Fallot: deleterious effects of residual pulmonary regurgitation. | journal=Br Heart J | year= 1992 | volume= 67 | issue= 6 | pages= 470-3 | pmid=1622697 | doi= | pmc=PMC1024889 | url= }} </ref> As right ventricular failure progresses, right ventricular dysfunction becomes more symptomatic. Symptoms may include: [[dyspnea on exertion]], [[peripheral edema]], [[ chest pain]] and [[fatigue]]. Patients may also complain of [[palpitations]], [[light-headedness]], as well as frank [[syncope]]. Advanced or later symptoms include the development of [[ascites]], right upper quadrant pain (as a result of hepatic distension), and [[early satiety]].<ref name="pmid15640261">{{cite journal| author=Bouzas B, Kilner PJ, Gatzoulis MA| title=Pulmonary regurgitation: not a benign lesion. | journal=Eur Heart J | year= 2005 | volume= 26 | issue= 5 | pages= 433-9 | pmid=15640261 | doi=10.1093/eurheartj/ehi091 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15640261 }} </ref> | |||
Prior to the age of 40, symptom onset is rare. Patients over 40 may potentially develop symptoms of right heart failure and present the risk of sudden cardiac death. <ref name="pmid15640261">{{cite journal| author=Bouzas B, Kilner PJ, Gatzoulis MA| title=Pulmonary regurgitation: not a benign lesion. | journal=Eur Heart J | year= 2005 | volume= 26 | issue= 5 | pages= 433-9 | pmid=15640261 | doi=10.1093/eurheartj/ehi091 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15640261 }} </ref><ref name="pmid6207619">{{cite journal| author=Shimazaki Y, Blackstone EH, Kirklin JW| title=The natural history of isolated congenital pulmonary valve incompetence: surgical implications. | journal=Thorac Cardiovasc Surg | year= 1984 | volume= 32 | issue= 4 | pages= 257-9 | pmid=6207619 | doi=10.1055/s-2007-1023399 | pmc= | url= }} </ref> | Prior to the age of 40, symptom onset is rare. Patients over 40 may potentially develop symptoms of right heart failure and present the risk of sudden cardiac death. <ref name="pmid15640261">{{cite journal| author=Bouzas B, Kilner PJ, Gatzoulis MA| title=Pulmonary regurgitation: not a benign lesion. | journal=Eur Heart J | year= 2005 | volume= 26 | issue= 5 | pages= 433-9 | pmid=15640261 | doi=10.1093/eurheartj/ehi091 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15640261 }} </ref><ref name="pmid6207619">{{cite journal| author=Shimazaki Y, Blackstone EH, Kirklin JW| title=The natural history of isolated congenital pulmonary valve incompetence: surgical implications. | journal=Thorac Cardiovasc Surg | year= 1984 | volume= 32 | issue= 4 | pages= 257-9 | pmid=6207619 | doi=10.1055/s-2007-1023399 | pmc= | url= }} </ref> | ||
Revision as of 20:06, 30 December 2016
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Pulmonic regurgitation Microchapters |
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Diagnosis |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Aravind Kuchkuntla, M.B.B.S[2]Aysha Anwar, M.B.B.S[3]
Overview
History and Symptoms
Clinical presentation of pulmonary regurgitation varies on the severity of the regurgitation and the right ventricular function.[1][2]
- Isolated pulmonary regurgitation is usually asymptomatic and is an incidental finding on 2D echo even when the regurgitation is severe.
- Patients with chronic PR develop right heart failure and present with the following symptoms:
- Intitial symptom of chronic PR is functional limitation of physical activity
- Ankle edema or swelling of the feet and legs
- Dyspnea on exertion
- Fatigue
- Hemoptysis or frothy sputum
- Nocturnal cough
- Palpitations or extra heart beats
- Patients with arrythmias present with palpitations, dizziness, or an episode of syncope[3][4] At this stage, research suggests that diagnostic measures such as exercise testing may indicate varying levels of exercise intolerance.[3][5] As right ventricular failure progresses, right ventricular dysfunction becomes more symptomatic. Symptoms may include: dyspnea on exertion, peripheral edema, chest pain and fatigue. Patients may also complain of palpitations, light-headedness, as well as frank syncope. Advanced or later symptoms include the development of ascites, right upper quadrant pain (as a result of hepatic distension), and early satiety.[3]
Prior to the age of 40, symptom onset is rare. Patients over 40 may potentially develop symptoms of right heart failure and present the risk of sudden cardiac death. [3][2]
References
- ↑ Warnes CA, Williams RG, Bashore TM, Child JS, Connolly HM, Dearani JA; et al. (2008). "ACC/AHA 2008 guidelines for the management of adults with congenital heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Develop Guidelines on the Management of Adults With Congenital Heart Disease). Developed in Collaboration With the American Society of Echocardiography, Heart Rhythm Society, International Society for Adult Congenital Heart Disease, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons". J Am Coll Cardiol. 52 (23): e143–263. doi:10.1016/j.jacc.2008.10.001. PMID 19038677.
- ↑ 2.0 2.1 Shimazaki Y, Blackstone EH, Kirklin JW (1984). "The natural history of isolated congenital pulmonary valve incompetence: surgical implications". Thorac Cardiovasc Surg. 32 (4): 257–9. doi:10.1055/s-2007-1023399. PMID 6207619.
- ↑ 3.0 3.1 3.2 3.3 Bouzas B, Kilner PJ, Gatzoulis MA (2005). "Pulmonary regurgitation: not a benign lesion". Eur Heart J. 26 (5): 433–9. doi:10.1093/eurheartj/ehi091. PMID 15640261.
- ↑ Wessel HU, Cunningham WJ, Paul MH, Bastanier CK, Muster AJ, Idriss FS (1980). "Exercise performance in tetralogy of Fallot after intracardiac repair". J Thorac Cardiovasc Surg. 80 (4): 582–93. PMID 7421291.
- ↑ Carvalho JS, Shinebourne EA, Busst C, Rigby ML, Redington AN (1992). "Exercise capacity after complete repair of tetralogy of Fallot: deleterious effects of residual pulmonary regurgitation". Br Heart J. 67 (6): 470–3. PMC 1024889. PMID 1622697.