Pulmonary regurgitation

Last updated
Pulmonary valve regurgitation
Other namesPulmonary insufficiency, pulmonary incompetence
Diagram of the human heart (cropped).svg
Diagram of the human heart
Specialty Cardiology
CausesPulmonary hypertension, Infective endocarditis [1]
Diagnostic method EKG, Echocardiogram [2]
TreatmentDepends on cause [3] (See cause)

Pulmonary (or pulmonic [4] ) regurgitation (or insufficiency, incompetence) is a condition in which the pulmonary valve is incompetent [5] and allows backflow from the pulmonary artery to the right ventricle of the heart during diastole. [6] While a small amount of backflow may occur ordinarily, it is usually only shown on an echocardiogram and is harmless. More pronounced regurgitation that is noticed through a routine physical examination is a medical sign of disease and warrants further investigation.[ medical citation needed ] If it is secondary to pulmonary hypertension it is referred to as a Graham Steell murmur. [7]

Contents

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. [3] However, more severe regurgitation may contribute to right ventricular enlargement by dilation, and in later stages, right heart failure. [8] A diastolic decrescendo murmur can sometimes be identified,( heard best) over the left lower sternal border.[ medical citation needed ]

Causes

Rheumatic heart disease Rheumatic heart disease, gross pathology 20G0013 lores.jpg
Rheumatic heart disease

Among the causes of pulmonary insufficiency are:

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. [12]

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. [2]

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). [13] Furthermore, pulmonary regurgitation is generally treated by addressing the underlying condition, [3] in certain cases, the pulmonary valve may be surgically replaced. [14]

See also

Related Research Articles

<span class="mw-page-title-main">Heart valve</span> A flap of tissue that prevent backflow of blood around the heart

A heart valve is a biological one-way valve that allows blood to flow in one direction through the chambers of the heart. Four valves are usually present in a mammalian heart and together they determine the pathway of blood flow through the heart. A heart valve opens or closes according to differential blood pressure on each side.

<span class="mw-page-title-main">Heart sounds</span> Noise generated by the beating heart

Heart sounds are the noises generated by the beating heart and the resultant flow of blood through it. Specifically, the sounds reflect the turbulence created when the heart valves snap shut. In cardiac auscultation, an examiner may use a stethoscope to listen for these unique and distinct sounds that provide important auditory data regarding the condition of the heart.

<span class="mw-page-title-main">Heart murmur</span> Medical condition

Heart murmurs are unique heart sounds produced when blood flows across a heart valve or blood vessel. This occurs when turbulent blood flow creates a sound loud enough to hear with a stethoscope. Turbulent blood flow is not smooth. The sound differs from normal heart sounds by their characteristics. For example, heart murmurs may have a distinct pitch, duration and timing. The major way health care providers examine the heart on physical exam is heart auscultation; another clinical technique is palpation, which can detect by touch when such turbulence causes the vibrations called cardiac thrill. A murmur is a sign found during the cardiac exam. Murmurs are of various types and are important in the detection of cardiac and valvular pathologies.

<span class="mw-page-title-main">Tetralogy of Fallot</span> Type of congenital heart defect

Tetralogy of Fallot (TOF), formerly known as Steno-Fallot tetralogy, is a congenital heart defect characterized by four specific cardiac defects. Classically, the four defects are:

<span class="mw-page-title-main">Ventricle (heart)</span> Chamber of the heart

A ventricle is one of two large chambers located toward the bottom of the heart that collect and expel blood towards the peripheral beds within the body and lungs. The blood pumped by a ventricle is supplied by an atrium, an adjacent chamber in the upper heart that is smaller than a ventricle. Interventricular means between the ventricles, while intraventricular means within one ventricle.

<span class="mw-page-title-main">Pulmonary heart disease</span> Medical condition

Pulmonary heart disease, also known as cor pulmonale, is the enlargement and failure of the right ventricle of the heart as a response to increased vascular resistance or high blood pressure in the lungs.

<span class="mw-page-title-main">Afterload</span> Pressure in the wall of the left ventricle during ejection

Afterload is the pressure that the heart must work against to eject blood during systole. Afterload is proportional to the average arterial pressure. As aortic and pulmonary pressures increase, the afterload increases on the left and right ventricles respectively. Afterload changes to adapt to the continually changing demands on an animal's cardiovascular system. Afterload is proportional to mean systolic blood pressure and is measured in millimeters of mercury.

<span class="mw-page-title-main">Mitral stenosis</span> Heart disease with narrowing of valve

Mitral stenosis is a valvular heart disease characterized by the narrowing of the opening of the mitral valve of the heart. It is almost always caused by rheumatic valvular heart disease. Normally, the mitral valve is about 5 cm2 during diastole. Any decrease in area below 2 cm2 causes mitral stenosis. Early diagnosis of mitral stenosis in pregnancy is very important as the heart cannot tolerate increased cardiac output demand as in the case of exercise and pregnancy. Atrial fibrillation is a common complication of resulting left atrial enlargement, which can lead to systemic thromboembolic complications such as stroke.

<span class="mw-page-title-main">Aortic regurgitation</span> Medical condition

Aortic regurgitation (AR), also known as aortic insufficiency (AI), is the leaking of the aortic valve of the heart that causes blood to flow in the reverse direction during ventricular diastole, from the aorta into the left ventricle. As a consequence, the cardiac muscle is forced to work harder than normal.

<span class="mw-page-title-main">Mitral regurgitation</span> Form of valvular heart disease

Mitral regurgitation (MR), also known as mitral insufficiency or mitral incompetence, is a form of valvular heart disease in which the mitral valve is insufficient and does not close properly when the heart pumps out blood. It is the abnormal leaking of blood backwards – regurgitation from the left ventricle, through the mitral valve, into the left atrium, when the left ventricle contracts. Mitral regurgitation is the most common form of valvular heart disease.

<span class="mw-page-title-main">Pulmonary atresia</span> Medical condition

Pulmonary atresia is a congenital malformation of the pulmonary valve in which the valve orifice fails to develop. The valve is completely closed thereby obstructing the outflow of blood from the heart to the lungs. The pulmonary valve is located on the right side of the heart between the right ventricle and pulmonary artery. In a normal functioning heart, the opening to the pulmonary valve has three flaps that open and close.

<span class="mw-page-title-main">Valvular heart disease</span> Disease in the valves of the heart

Valvular heart disease is any cardiovascular disease process involving one or more of the four valves of the heart. These conditions occur largely as a consequence of aging, but may also be the result of congenital (inborn) abnormalities or specific disease or physiologic processes including rheumatic heart disease and pregnancy.

<span class="mw-page-title-main">Atrioventricular septal defect</span> Medical condition

Atrioventricular septal defect (AVSD) or atrioventricular canal defect (AVCD), also known as "common atrioventricular canal" or "endocardial cushion defect" (ECD), is characterized by a deficiency of the atrioventricular septum of the heart that creates connections between all four of its chambers. It is a very specific combination of 3 defects:

<span class="mw-page-title-main">Pulmonary valve stenosis</span> Medical condition

Pulmonary valve stenosis (PVS) is a heart valve disorder. Blood going from the heart to the lungs goes through the pulmonary valve, whose purpose is to prevent blood from flowing back to the heart. In pulmonary valve stenosis this opening is too narrow, leading to a reduction of flow of blood to the lungs.

<span class="mw-page-title-main">Right ventricular hypertrophy</span> Medical condition

Right ventricular hypertrophy (RVH) is a condition defined by an abnormal enlargement of the cardiac muscle surrounding the right ventricle. The right ventricle is one of the four chambers of the heart. It is located towards the lower-end of the heart and it receives blood from the right atrium and pumps blood into the lungs.

Regurgitation is blood flow in the opposite direction from normal, as the backward flowing of blood into the heart or between heart chambers. It is the circulatory equivalent of backflow in engineered systems. It is sometimes called reflux.

<span class="mw-page-title-main">Tricuspid regurgitation</span> Type of valvular heart disease

Tricuspid regurgitation (TR), also called tricuspid insufficiency, is a type of valvular heart disease in which the tricuspid valve of the heart, located between the right atrium and right ventricle, does not close completely when the right ventricle contracts (systole). TR allows the blood to flow backwards from the right ventricle to the right atrium, which increases the volume and pressure of the blood both in the right atrium and the right ventricle, which may increase central venous volume and pressure if the backward flow is sufficiently severe.

A plot of a system's pressure versus volume has long been used to measure the work done by the system and its efficiency. This analysis can be applied to heat engines and pumps, including the heart. A considerable amount of information on cardiac performance can be determined from the pressure vs. volume plot. A number of methods have been determined for measuring PV-loop values experimentally.

<span class="mw-page-title-main">Heart failure with preserved ejection fraction</span> Medical condition

Heart failure with preserved ejection fraction (HFpEF) is a form of heart failure in which the ejection fraction – the percentage of the volume of blood ejected from the left ventricle with each heartbeat divided by the volume of blood when the left ventricle is maximally filled – is normal, defined as greater than 50%; this may be measured by echocardiography or cardiac catheterization. Approximately half of people with heart failure have preserved ejection fraction, while the other half have a reduction in ejection fraction, called heart failure with reduced ejection fraction (HFrEF).

References

  1. 1 2 3 4 Booker, Peter D. (2005). Pediatric cardiac anesthesia (4th ed.). Philadelphia: Lippincott Williams & Wilkins. p. 430. ISBN   978-0-7817-5175-9 . Retrieved 30 August 2015.
  2. 1 2 "Pulmonary Valve Disease. About Pulmonary valve disease | Patient". Patient. Retrieved 2015-08-29.
  3. 1 2 3 McGlothlin, edited by Michael H. Crawford, Komandoor Srivathson, Dana P. (2006). Current consult. New York, NY: Lange Medical Books/McGraw-Hill. p. 269. ISBN   978-0-07144-010-3.{{cite book}}: |first1= has generic name (help)CS1 maint: multiple names: authors list (link)
  4. ↑ T. R. Harrison (ed.): Principles of Internal Medicine, Third Edition, McGraw-Hill, New York / Toronto / London 1958, p. 1258.
  5. ↑ "Pulmonary Insufficiency". FreeDictionary. Farlex. 2014. Retrieved 29 August 2015.
  6. ↑ White, Charles S.; Haramati, Linda B.; Chen, Joseph Jen-Sho; Levsky, Jeffrey M. (2014-03-01). Cardiac Imaging. OUP USA. p. 402. ISBN   9780199829477.
  7. ↑ Auscultation Skills: Breath & Heart Sounds. Lippincott Williams & Wilkins. 2009-10-01. p. 83. ISBN   9781605474540.
  8. 1 2 3 "Pulmonic Regurgitation Clinical Presentation". Medscale.com. eMedicine. Retrieved 29 August 2015.
  9. ↑ "pulmonary Valve disease". Patient.info. EMIS Group. Retrieved 29 August 2015.
  10. ↑ Alpert, Joseph (2012). Cardiology and the Primary care Physician (3rd ed.). Current Medicine. p. 306. ISBN   978-1-4615-6603-8 . Retrieved 29 August 2015.
  11. ↑ O'Connor, Nicholas J. Talley, Simon (2014). Clinical examination : a systematic guide to physical diagnosis (Seventh ed.). Sydney [etc.]: Elsevier, Churchill Livingstone. p. 108. ISBN   978-0-72954-147-3 . Retrieved 29 August 2015.{{cite book}}: CS1 maint: multiple names: authors list (link)
  12. ↑ Chaturvedi, Rajiv R; Redington, Andrew N (2007-07-01). "Pulmonary regurgitation in congenital heart disease". Heart. 93 (7): 880–889. doi:10.1136/hrt.2005.075234. ISSN   1355-6037. PMC   1994453 . PMID   17569817.
  13. ↑ "Pulmonic Regurgitation Treatment & Management: Medical Care, Surgical Care, Consultations". 2018-06-28.{{cite journal}}: Cite journal requires |journal= (help)
  14. ↑ "Heart valve surgery: MedlinePlus Medical Encyclopedia". www.nlm.nih.gov. Retrieved 2015-08-30.

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