X hits on this document

PDF document

Common Congenital Heart Lesions - page 24 / 126

445 views

0 shares

0 downloads

0 comments

24 / 126

24 of 126

Regurgitant Semilunar Valve Disease Pulmonic Regurgitation (PR)

Clinical Presentation: (most of these occur in patients with any cause of right-sided heart failure)

  • Dyspnea on exertion is most common

  • Easy fatigability

  • light-headedness

  • peripheral edema

  • chest pain

  • palpitations

  • syncope

  • Note: In more advanced presentations of right-sided heart failure, abdominal distension secondary to ascites, right

upper quadrant pain secondary to hepatic distension, and early satiety may occur.

Physical Exam: Typical findings:

  • o

    Auscultation:

    • High-pitched decrescendo murmur along the left sternal border – often indistinguishable from AR

    • In pulmonary hypertension with PR, P2 is accentuated – with increased RV end-diastolic volume, ejection time is increased, P2 is delayed, and S2 split is widened.

    • o

      Jugular venous pressure: usually increased; increased “a” wave is often present

    • o

      Palpation: RV systolic pulsation sometimes noted at the left lower sternal border due to RV enlargement;

palpable pulmonary artery pulsation at left upper sternal border if patient has significant pulmonary artery dilatation

Etiology:

  • PR most commonly develops in setting of severe pulmonary hypertension and results from dilatation of the

valve ring by the enlarged pulmonary artery.

Pathophysiology:

  • Incompetence of the pulmonic valve occurs is caused three pathologic processes:

    • 1.

      dilatation of the pulmonic valve ring

    • 2.

      acquired alteration of pulmonic valve cusp morphology

    • 3.

      congenital absence or malformation

Diagnostic imaging/testing:

  • Chest X-Ray:

    • o

      If have PR with pulmonary hypertension, can see: prominent central pulmonary arteries w/ enlarged hilar vessels and loss of vascularity in peripheral lung fields ("pruning")

  • Echocardiography: Doppler echocardiography can easily identify between AR and PR – as their murmurs sound

the same and can be indistinguishable.

  • Electrocardiogram: may show right axis deviation due to RVH; can also show RA dilation if back-up is

happening

Treatment:

  • PR seldom severe enough to warrant special treatment because RV normally adapts to low-pressure volume

overload without difficulty.

Document info
Document views445
Page views445
Page last viewedSat Jan 21 11:25:20 UTC 2017
Pages126
Paragraphs5002
Words33792

Comments