Pulmonary regurgitation

Signs and symptoms

Because pulmonic regurgitation is the result of other factors in the body, any noticeable symptoms are ultimately caused by an underlying medical condition rather than the regurgitation itself. However, more severe regurgitation may contribute to right ventricular enlargement by dilation, and in later stages, right heart failure. A diastolic decrescendo murmur can sometimes be identified,( heard best) over the left lower sternal border.

Causes

Among the causes of pulmonary insufficiency are:

• Pulmonary hypertension
• Infective endocarditis
• Rheumatic heart disease
• Connective tissue disease
• Carcinoid syndrome
• Congenital abnormalities
• Tetralogy of Fallot,
• Prosthetic heart valve

Pathophysiology

The pathophysiology is due to diastolic pressure variations between the pulmonary artery and right ventricle, differences are often very small, but increase regurgitation. An elevation in pulmonary insufficiency due to elevated intrathoracic pressure is relevant in ventilated patients (having acute restrictive right ventricular physiology). The reasons for changes in stiffness of the right ventricle's walls are not well understood, but such stiffness is thought to increase with hypertrophy of the ventricle.

Diagnosis

In the diagnosis of pulmonary regurgitation both echocardiograms and ECG is used to ascertain if the individual has this condition, as well as, the use of a chest X-ray to expose enlargement of the right atrium or ventricle.

Treatment

In treating pulmonary regurgitation, it should be determined if pulmonary hypertension is causing the problem to therefore begin the most appropriate therapy as soon as possible (primary pulmonary hypertension or secondary pulmonary hypertension due to thromboembolism). Furthermore, pulmonary regurgitation is generally treated by addressing the underlying condition, in certain cases, the pulmonary valve may be surgically replaced.

References

References

1. T. R. Harrison (ed.): ''Principles of Internal Medicine'', Third Edition, McGraw-Hill, New York / Toronto / London 1958, p. 1258.
2. (2014). "Pulmonary Insufficiency". Farlex.
3. (2014-03-01). "Cardiac Imaging". OUP USA.
4. (2009-10-01). "Auscultation Skills: Breath & Heart Sounds". Lippincott Williams & Wilkins.
5. (2005). "Pediatric cardiac anesthesia". Lippincott Williams & Wilkins.
6. "Pulmonic Regurgitation Clinical Presentation". eMedicine.
7. "pulmonary Valve disease". EMIS Group.
8. (2012). "Cardiology and the Primary care Physician". Current Medicine.
9. (2014). "Clinical examination : a systematic guide to physical diagnosis". Elsevier, Churchill Livingstone.
10. (2007-07-01). "Pulmonary regurgitation in congenital heart disease". Heart.
11. "Pulmonary Valve Disease. About Pulmonary valve disease {{!}} Patient".
12. (14 June 2021). "Pulmonary Regurgitation (Pulmonic Regurgitation) Treatment & Management: Approach Considerations, Medical Care, Surgical Care".
13. (2006). "Current consult.". Lange Medical Books/McGraw-Hill.
14. "Heart valve surgery: MedlinePlus Medical Encyclopedia".