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'''Pulmonary insufficiency''' (or '''incompetence''', or '''regurgitation''') is a condition in which the [[pulmonary valve]] is incompetent<ref>{{Cite web|url = http://medical-dictionary.thefreedictionary.com/pulmonary+valve+insufficiency|title = Pulmonary Insufficiency|date = 2014|accessdate =29 August 2015|website = FreeDictionary|publisher = Farlex|last = |first = }}</ref> and allows [[Regurgitation (circulation)|backflow]] from the [[pulmonary artery]] to the [[right ventricle]] of the [[heart]] during [[diastole]].<ref>{{Cite book|title = Cardiac Imaging|url = https://books.google.com/books?id=bEhYAgAAQBAJ|publisher = OUP USA|date = 2014-03-01|page=402|isbn = 9780199829477|first = Charles S.|last = White|first2 = Linda B.|last2 = Haramati|first3 = Joseph Jen-Sho|last3 = Chen|first4 = Jeffrey M.|last4 = Levsky}}</ref> 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|date=August 2015}} If it is secondary to [[pulmonary hypertension]] it is referred to as a [[Graham Steell murmur]].<ref>{{Cite book|title = Auscultation Skills: Breath & Heart Sounds|url = https://books.google.com/books?id=CWr4EEyKZ4wC|publisher = Lippincott Williams & Wilkins|date = 2009-10-01|page=83|isbn = 9781605474540}}</ref>
'''Pulmonary insufficiency''' (or '''incompetence''', or '''regurgitation''') is a condition in which the [[pulmonary valve]] is incompetent<ref>{{Cite web|url = http://medical-dictionary.thefreedictionary.com/pulmonary+valve+insufficiency|title = Pulmonary Insufficiency|date = 2014|accessdate =29 August 2015|website = FreeDictionary|publisher = Farlex|last = |first = }}</ref> and allows [[Regurgitation (circulation)|backflow]] from the [[pulmonary artery]] to the [[right ventricle]] of the [[heart]] during [[diastole]].<ref>{{Cite book|title = Cardiac Imaging|url = https://books.google.com/books?id=bEhYAgAAQBAJ|publisher = OUP USA|date = 2014-03-01|page=402|isbn = 9780199829477|first1 = Charles S.|last1 = White|first2 = Linda B.|last2 = Haramati|first3 = Joseph Jen-Sho|last3 = Chen|first4 = Jeffrey M.|last4 = Levsky}}</ref> 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|date=August 2015}} If it is secondary to [[pulmonary hypertension]] it is referred to as a [[Graham Steell murmur]].<ref>{{Cite book|title = Auscultation Skills: Breath & Heart Sounds|url = https://books.google.com/books?id=CWr4EEyKZ4wC|publisher = Lippincott Williams & Wilkins|date = 2009-10-01|page=83|isbn = 9781605474540}}</ref>


==Signs and symptoms==
==Signs and symptoms==
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{{columns-list|colwidth=30em|
{{columns-list|colwidth=30em|
* [[Pulmonary hypertension]]<ref name="booker2005">{{cite book|last1=Booker|first1=editors, Carol L. Lake, Peter D.|title=Pediatric cardiac anesthesia|date=2005|publisher=Lippincott Williams & Wilkins|location=Philadelphia|isbn=978-0-7817-5175-9|page=430|edition=4th|url=https://books.google.com/?id=ymuHmUWuUsAC&pg=PA430&dq=Pulmonary+hypertension+causes+Pulmonary+insufficiency#v=onepage&q=Pulmonary%20hypertension%20causes%20Pulmonary%20insufficiency&f=false|accessdate=30 August 2015}}</ref>
* [[Pulmonary hypertension]]<ref name="booker2005">{{cite book|last1=Booker|first1=editors, Carol L. Lake, Peter D.|title=Pediatric cardiac anesthesia|date=2005|publisher=Lippincott Williams & Wilkins|location=Philadelphia|isbn=978-0-7817-5175-9|page=430|edition=4th|url=https://books.google.com/books?id=ymuHmUWuUsAC&pg=PA430&dq=Pulmonary+hypertension+causes+Pulmonary+insufficiency#v=onepage|accessdate=30 August 2015}}</ref>
* [[Infective endocarditis]]<ref name=booker2005/>
* [[Infective endocarditis]]<ref name=booker2005/>
* [[Rheumatic heart disease]]<ref name=booker2005/>
* [[Rheumatic heart disease]]<ref name=booker2005/>
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* [[Carcinoid syndrome]]<ref name=eMedicine2015/>
* [[Carcinoid syndrome]]<ref name=eMedicine2015/>
* Congestive abnormalities<ref>{{cite web|title=pulmonary Valve disease|url=http://patient.info/doctor/pulmonary-valve-disease|website=Patient.info|publisher=EMIS Group|accessdate=29 August 2015}}</ref>
* Congestive abnormalities<ref>{{cite web|title=pulmonary Valve disease|url=http://patient.info/doctor/pulmonary-valve-disease|website=Patient.info|publisher=EMIS Group|accessdate=29 August 2015}}</ref>
* [[Tetralogy of Fallot]],<ref>{{cite book|last1=Alpert|first1=Joseph|title=Cardiology and the Primary care Physician|date=2012|publisher=Current Medicine|isbn=978-1-4615-6603-8|page=306|edition=3rd|url=https://books.google.com/?id=x2D1BwAAQBAJ&pg=PA305&dq=Tetralogy+of+Fallot,+causes+Pulmonary+insufficiency#v=onepage&q=Tetralogy%20of%20Fallot%2C%20causes%20Pulmonary%20insufficiency&f=false|accessdate=29 August 2015}}</ref>
* [[Tetralogy of Fallot]],<ref>{{cite book|last1=Alpert|first1=Joseph|title=Cardiology and the Primary care Physician|date=2012|publisher=Current Medicine|isbn=978-1-4615-6603-8|page=306|edition=3rd|url=https://books.google.com/books?id=x2D1BwAAQBAJ&pg=PA305&dq=Tetralogy+of+Fallot,+causes+Pulmonary+insufficiency#v=onepage|accessdate=29 August 2015}}</ref>
* [[Prosthetic heart valve]]<ref>{{cite book|last1=O'Connor|first1=Nicholas J. Talley, Simon|title=Clinical examination : a systematic guide to physical diagnosis|date=2014|publisher=Elsevier, Churchill Livingstone|location=Sydney [etc.]|isbn=978-0-72954-147-3|page=108|edition=Seventh|url=https://books.google.com/?id=cTFkBgAAQBAJ&pg=PA108&lpg=PA108&dq=Prosthetic+heart+valve+causes+Pulmonary+insufficiency#v=onepage&q=Prosthetic%20heart%20valve%20causes%20Pulmonary%20insufficiency&f=false|accessdate=29 August 2015}}</ref>
* [[Prosthetic heart valve]]<ref>{{cite book|last1=O'Connor|first1=Nicholas J. Talley, Simon|title=Clinical examination : a systematic guide to physical diagnosis|date=2014|publisher=Elsevier, Churchill Livingstone|location=Sydney [etc.]|isbn=978-0-72954-147-3|page=108|edition=Seventh|url=https://books.google.com/books?id=cTFkBgAAQBAJ&pg=PA108&lpg=PA108&dq=Prosthetic+heart+valve+causes+Pulmonary+insufficiency#v=onepage|accessdate=29 August 2015}}</ref>
}}
}}


==Pathophysiology==
==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 [[Mechanical ventilation|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.<ref>{{Cite journal|title = Pulmonary regurgitation in congenital heart disease|journal = Heart|date = 2007-07-01|issn = 1355-6037|pmc = 1994453|pmid = 17569817|pages = 880–889|volume = 93|issue = 7|doi = 10.1136/hrt.2005.075234|first = Rajiv R|last = Chaturvedi|first2 = Andrew N|last2 = Redington}}</ref>
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 [[Mechanical ventilation|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.<ref>{{Cite journal|title = Pulmonary regurgitation in congenital heart disease|journal = Heart|date = 2007-07-01|issn = 1355-6037|pmc = 1994453|pmid = 17569817|pages = 880–889|volume = 93|issue = 7|doi = 10.1136/hrt.2005.075234|first1 = Rajiv R|last1 = Chaturvedi|first2 = Andrew N|last2 = Redington}}</ref>


==Diagnosis==
==Diagnosis==
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==Further reading==
==Further reading==
* {{Cite book|title = Pediatric Cardiac Anesthesia|url = https://books.google.com/books?id=ymuHmUWuUsAC|publisher = Lippincott Williams & Wilkins|date = 2005-01-01|isbn = 9780781751759|first = Carol L.|last = Lake|first2 = Peter D.|last2 = Booker}}
* {{Cite book|title = Pediatric Cardiac Anesthesia|url = https://books.google.com/books?id=ymuHmUWuUsAC|publisher = Lippincott Williams & Wilkins|date = 2005-01-01|isbn = 9780781751759|first1 = Carol L.|last1 = Lake|first2 = Peter D.|last2 = Booker}}
* {{Cite journal|title = Right-Sided Valve Disease Deserves a Little More Respect|journal = Circulation|date = 2009-05-26|issn = 0009-7322|pmid = 19470901|pages = 2726–2734|volume = 119|issue = 20|doi = 10.1161/CIRCULATIONAHA.108.776021|first = Charles J.|last = Bruce|first2 = Heidi M.|last2 = Connolly|doi-access = free}}
* {{Cite journal|title = Right-Sided Valve Disease Deserves a Little More Respect|journal = Circulation|date = 2009-05-26|issn = 0009-7322|pmid = 19470901|pages = 2726–2734|volume = 119|issue = 20|doi = 10.1161/CIRCULATIONAHA.108.776021|first1 = Charles J.|last1 = Bruce|first2 = Heidi M.|last2 = Connolly|doi-access = free}}
* {{Cite book|title = Understanding Pediatric Heart Sounds|url = https://books.google.com/books?id=G5Y8TUKfJZYC|publisher = Steven Lehrer|date = 2011-12-27|isbn = 9781468138030|first = Steven Lehrer|last = M.D}}
* {{Cite book|title = Understanding Pediatric Heart Sounds|url = https://books.google.com/books?id=G5Y8TUKfJZYC|publisher = Steven Lehrer|date = 2011-12-27|isbn = 9781468138030|first = Steven Lehrer|last = M.D}}


Revision as of 19:20, 22 July 2020

Pulmonary valve insufficiency
Other namesPulmonary regurgitation, pulmonary incompetence
Diagram of the human heart
SpecialtyCardiology
CausesPulmonary hypertension, Infective endocarditis[1]
Diagnostic methodEKG, Echocardiogram[2]
TreatmentDepends on cause[3](See cause)

Pulmonary insufficiency (or incompetence, or regurgitation) is a condition in which the pulmonary valve is incompetent[4] and allows backflow from the pulmonary artery to the right ventricle of the heart during diastole.[5] 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.[6]

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.[7] A diastolic decrescendo murmur can sometimes be identified,( heard best) over the left lower sternal border.[medical citation needed]

Causes

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.[11]

Diagnosis

In the diagnosis of pulmonary insufficiency both echocardiograms and EKG 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 insufficiency, 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).[12] Furthermore, pulmonary insufficiency is generally treated by addressing the underlying condition,[3] in certain cases, the pulmonary valve may be surgically replaced.[13]

See also

References

  1. ^ a b c d Booker, editors, Carol L. Lake, Peter D. (2005). Pediatric cardiac anesthesia (4th ed.). Philadelphia: Lippincott Williams & Wilkins. p. 430. ISBN 978-0-7817-5175-9. Retrieved 30 August 2015. {{cite book}}: |first1= has generic name (help)CS1 maint: multiple names: authors list (link)
  2. ^ a b "Pulmonary Valve Disease. About Pulmonary valve disease | Patient". Patient. Retrieved 2015-08-29.
  3. ^ a b c 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. ^ "Pulmonary Insufficiency". FreeDictionary. Farlex. 2014. Retrieved 29 August 2015.
  5. ^ White, Charles S.; Haramati, Linda B.; Chen, Joseph Jen-Sho; Levsky, Jeffrey M. (2014-03-01). Cardiac Imaging. OUP USA. p. 402. ISBN 9780199829477.
  6. ^ Auscultation Skills: Breath & Heart Sounds. Lippincott Williams & Wilkins. 2009-10-01. p. 83. ISBN 9781605474540.
  7. ^ a b c "Pulmonic Regurgitation Clinical Presentation". Medscale.com. eMedicine. Retrieved 29 August 2015.
  8. ^ "pulmonary Valve disease". Patient.info. EMIS Group. Retrieved 29 August 2015.
  9. ^ 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.
  10. ^ 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)
  11. ^ 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.
  12. ^ "Pulmonic Regurgitation Treatment & Management: Medical Care, Surgical Care, Consultations". 2018-06-28. {{cite journal}}: Cite journal requires |journal= (help)
  13. ^ "Heart valve surgery: MedlinePlus Medical Encyclopedia". www.nlm.nih.gov. Retrieved 2015-08-30.

Further reading

External links

Scholia has a topic profile for Pulmonary regurgitation.
Retrieved from "https://en.wikipedia.org/w/index.php?title=Pulmonary_regurgitation&oldid=968994688"