Pulmonic regurgitation physical examination
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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
Physical examination findings of pulmonary regurgitation includes increased JVP, prominent "a" wave, "v" wave in the neck. A palpable apical impulse (lift or heave) is usually present at the left lower sternal border because of right ventricular dilation. On auscultation, it may be associated with wide splitting of S2 with right sided S3 accentuated with respiration. Murmur of pulmonic regurgitation may vary depending on the underlying cause.[1][2]
Physical Examination
Neck
- Raised JVP[3]
- Prominent "a wave" may be present.
- Prominent "v wave" may be present in presence of tricuspid regurgitation.
Palpation
- Apical impulse (lift or heave) is usually present at the left lower sternal border because of right ventricular dilation.
- right ventricular heave may be present due to pulmonary hypertension.[4]
Auscultation
Heart Sounds
- Pulmonic regurgitation is associated with wide splitting of S2.
- P2 is accentuated due to pulmonary hypertension[5].
- P2 is absent/inaudible in case of, absent pulmonic valves (congenital or secondary to surgical resection).[6]
- A right-sided S3 may be audible and may also be accentuated with inspiration.
- Likewise, a right-sided S4 may also be audible and accentuated with inspiration.
Murmur
- Classically a high-pitched early-diastolic murmur is heard at left upper sternal area.[7]
- Murmur of residual pulmonic regurgitation after Tetralogy of Fallot repair:[1]
- It is a low-pitched and soft murmur.
- Best heard along with the second or third intercostal spaces adjacent to the left sternal border.
- It is accentuated by squatting and inspiration.
- It is made softer by Valsalva maneuvers or expiration.
- Murmur of pulmonic regurgitation associated with Pulmonic hypertension:[2]
- When the pulmonary artery systolic pressure exceeds 60 mm Hg, dilatation of the pulmonary artery ring may then result in Graham-Steell's murmur.
- It is a high-pitched, "blowing", early diastolic decrescendo murmurs like that of aortic regurgitation.
- Best heard along the left parasternal region.
- It is accentuated by inspiration.
References
- ↑ 1.0 1.1 Bousvaros, GeorgeA.; Deuchar, DennisC. (1961). "THE MURMUR OF PULMONARY REGURGITATION WHICH IS NOT ASSOCIATED WITH PULMONARY HYPERTENSION". The Lancet. 278 (7209): 962–964. doi:10.1016/S0140-6736(61)90798-X. ISSN 0140-6736.
- ↑ 2.0 2.1 Würtemberger G, Dinkel E, Joos A, Matthys H (1989). "[Pulmonary hypertension. Clinical picture and therapy]". Radiologe. 29 (6): 263–6. PMID 2662241.
- ↑ Khavandi, Ali (2014). Essential revision notes for the cardiology KBA. Oxford: Oxford University Press. ISBN 978-0199654901.
- ↑ Khavandi, Ali (2014). Essential revision notes for the cardiology KBA. Oxford: Oxford University Press. ISBN 978-0199654901.
- ↑ Khavandi, Ali (2014). Essential revision notes for the cardiology KBA. Oxford: Oxford University Press. ISBN 978-0199654901.
- ↑ Khavandi, Ali (2014). Essential revision notes for the cardiology KBA. Oxford: Oxford University Press. ISBN 978-0199654901.
- ↑ Khavandi, Ali (2014). Essential revision notes for the cardiology KBA. Oxford: Oxford University Press. ISBN 978-0199654901.