Medicine:Pulmonary insufficiency

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

Pulmonary (or pulmonic[4]) insufficiency (or incompetence, or regurgitation) 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. If it is secondary to pulmonary hypertension it is referred to as a Graham Steell murmur.[7]

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.

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.[12]

Diagnosis

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

See also

References

  1. ↑ 1.0 1.1 1.2 1.3 Booker, Peter D. (2005). Pediatric cardiac anesthesia (4th ed.). Philadelphia: Lippincott Williams & Wilkins. p. 430. ISBN 978-0-7817-5175-9. https://books.google.com/books?id=ymuHmUWuUsAC&q=Pulmonary+hypertension+causes+Pulmonary+insufficiency&pg=PA430. Retrieved 30 August 2015. 
  2. ↑ 2.0 2.1 "Pulmonary Valve Disease. About Pulmonary valve disease | Patient". http://patient.info/doctor/pulmonary-valve-disease. 
  3. ↑ 3.0 3.1 3.2 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. 
  4. ↑ T. R. Harrison (ed.): Principles of Internal Medicine, Third Edition, McGraw-Hill, New York / Toronto / London 1958, p. 1258.
  5. ↑ "Pulmonary Insufficiency". Farlex. 2014. http://medical-dictionary.thefreedictionary.com/pulmonary+valve+insufficiency. 
  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. https://books.google.com/books?id=bEhYAgAAQBAJ. 
  7. ↑ Auscultation Skills: Breath & Heart Sounds. Lippincott Williams & Wilkins. 2009-10-01. p. 83. ISBN 9781605474540. https://books.google.com/books?id=CWr4EEyKZ4wC. 
  8. ↑ 8.0 8.1 8.2 "Pulmonic Regurgitation Clinical Presentation". eMedicine. http://emedicine.medscape.com/article/157639-clinical. 
  9. ↑ "pulmonary Valve disease". EMIS Group. http://patient.info/doctor/pulmonary-valve-disease. 
  10. ↑ Alpert, Joseph (2012). Cardiology and the Primary care Physician (3rd ed.). Current Medicine. p. 306. ISBN 978-1-4615-6603-8. https://books.google.com/books?id=x2D1BwAAQBAJ&q=Tetralogy+of+Fallot,+causes+Pulmonary+insufficiency&pg=PA305. 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. https://books.google.com/books?id=cTFkBgAAQBAJ&q=Prosthetic+heart+valve+causes+Pulmonary+insufficiency&pg=PA108. Retrieved 29 August 2015. 
  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. PMID 17569817. 
  13. ↑ Pulmonic Regurgitation Treatment & Management: Medical Care, Surgical Care, Consultations. 2018-06-28. http://emedicine.medscape.com/article/157639-treatment. 
  14. ↑ "Heart valve surgery: MedlinePlus Medical Encyclopedia". https://www.nlm.nih.gov/medlineplus/ency/article/002954.htm. 

Further reading

External links

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