Pulmonic regurgitation physical examination
|
Pulmonic regurgitation Microchapters |
|
Diagnosis |
|---|
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:[1]
- 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.
References
- ↑ 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.