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
Neck
- Increased JVP
- Prominent "a wave" may be present
- Prominent "v wave" may be present in presence of tricuspid regurgitation
Palpation
- A palpable impulse (lift or heave) is usually present at the left lower sternal border because of right ventricular dilation.
Auscultation
Heart Sounds
- Pulmonic regurgitation is associated with wide splitting of S2.
- P2 is accentuated because of presence of pulmonary regurgitation. In case of, absence of pulmonic valves (congenital or secondary to surgical resection), P2 is inaudible.
- 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
- Murmur of residual pulmonic regurgitation after Tetralogy of Fallot repair:
- It is a low-pitched and soft murmur.
- Best heard along 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:
- 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 murmur like that of aortic regurgitation.
- Best heard along the left parasternal region.
- It is accentuated by inspiration.
Sources
- Bouzbas, B., Kilner, P. J., & Gatzoulis, M. A. (2005). Pulmonary regurgitation: not a benign lesion. European Heart Journal, 433-9. [1]
- Wessel, H. U., Cunningham, W. J., Paul, M. H., Bastanier, C. K., Muster, A. J., & Idriss, F. S. (1980). Exercise performance in tetralogy of Fallot after intracardiac repair. Journal of Thoracic and Cardiovascular Surgery, 582-93. [2]
- Shimazaki, Y., Blackstone, E. H., & Kirklin, J. W. (1984). The natural history of isolated congenital pulmonary valve incompetence: surgical implications. Journal of Thoracic and Cardiovascular Surgery, 257-9. [3]
- Geva, T., Sandweiss, B. M., Gauvreau, K., Lock, J. E., & Powell, A. (2004). Factors associated with impaired clinical status in long-term survivors of tetralogy of Fallot repair evaluated by magnetic resonance imaging. Journal of the American College of Cardiology, 1068-74. [4]
References
- ↑ 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.
- ↑ 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.
- ↑ Geva T, Sandweiss BM, Gauvreau K, Lock JE, Powell AJ (2004). "Factors associated with impaired clinical status in long-term survivors of tetralogy of Fallot repair evaluated by magnetic resonance imaging". J Am Coll Cardiol. 43 (6): 1068–74. doi:10.1016/j.jacc.2003.10.045. PMID 15028368.