Pulmonic regurgitation history and symptoms: Difference between revisions
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==Overview== | ==Overview== | ||
Clinical presentation of [[pulmonary regurgitation]] varies | Clinical presentation of [[pulmonary regurgitation]] varies with the severity of the [[regurgitation]] and [[right ventricular dysfunction]]. Isolated [[pulmonary regurgitation]] is usually asymptomatic. However, patients with chronic [[PR]] may present with [[symptoms]] of [[heart failure]] such as [[ankle edema]], swelling of feet or legs, [[dyspnea on exertion]], [[fatigue]], [[hemoptysis]], nocturnal [[cough]] and [[palpitations]].<ref name="pmid19038677">{{cite journal| author=Warnes CA, Williams RG, Bashore TM, Child JS, Connolly HM, Dearani JA et al.| title=ACC/AHA 2008 guidelines for the management of adults with congenital heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Develop Guidelines on the Management of Adults With Congenital Heart Disease). Developed in Collaboration With the American Society of Echocardiography, Heart Rhythm Society, International Society for Adult Congenital Heart Disease, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. | journal=J Am Coll Cardiol | year= 2008 | volume= 52 | issue= 23 | pages= e143-263 | pmid=19038677 | doi=10.1016/j.jacc.2008.10.001 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19038677 }} </ref><ref name="pmid6207619">{{cite journal| author=Shimazaki Y, Blackstone EH, Kirklin JW| title=The natural history of isolated congenital pulmonary valve incompetence: surgical implications. | journal=Thorac Cardiovasc Surg | year= 1984 | volume= 32 | issue= 4 | pages= 257-9 | pmid=6207619 | doi=10.1055/s-2007-1023399 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6207619 }} </ref> | ||
==History and | ==History== | ||
Clinical presentation of [[pulmonary regurgitation]] varies | ===Patient history=== | ||
===Past medical history=== | |||
===Family history=== | |||
A family history of [[TOF]] or [[autosomal dominant]] causes of [[PR]] such as [[Marfan syndrome]] may be helpful in determining the cause of the [[disease]]. | |||
===Social history=== | |||
*'''Smoking''': [[PAH]] a common cause of [[PR]]. Tobacco [[smoking]] is a risk factor for developing [[PAH]].<ref name="pmid20472864">{{cite journal |vauthors=Schiess R, Senn O, Fischler M, Huber LC, Vatandaslar S, Speich R, Ulrich S |title=Tobacco smoke: a risk factor for pulmonary arterial hypertension? A case-control study |journal=Chest |volume=138 |issue=5 |pages=1086–92 |date=November 2010 |pmid=20472864 |doi=10.1378/chest.09-2962 |url=}}</ref> Although, no direct correlation between smoking and [[PR]] has been reported, a history of smoking or associated [[COPD]] may be required for [[pre-operative clearance]]in case a corrective surgery is planned. | |||
*'''[[Intravenous drug use (recreational)]]''': [[Infective endocarditis]] although an uncommon cause of [[PR]] is overwhelmingly a disease of [[Intravenous drug use (recreational)|IV drug abuse]]. In an urban university hospital NJ, USA, s prospective study reported that 13% of [[Intravenous drug use (recreational)|IV injection users]] with [[fever]] have [[echocardiographic]] evidence of [[IE]].<ref name="pmid8452151">{{cite journal |vauthors=Weisse AB, Heller DR, Schimenti RJ, Montgomery RL, Kapila R |title=The febrile parenteral drug user: a prospective study in 121 patients |journal=Am. J. Med. |volume=94 |issue=3 |pages=274–80 |date=March 1993 |pmid=8452151 |doi=10.1016/0002-9343(93)90059-x |url=}}</ref> Although [[pulmonary valve]] involvement is rare, but cases of [[PR]] among [[IV]] drug users have been reported.<ref name="pmid1524330">{{cite journal |vauthors=Hecht SR, Berger M |title=Right-sided endocarditis in intravenous drug users. Prognostic features in 102 episodes |journal=Ann. Intern. Med. |volume=117 |issue=7 |pages=560–6 |date=October 1992 |pmid=1524330 |doi=10.7326/0003-4819-117-7-560 |url=}}</ref><ref name="pmid12695478">{{cite journal |vauthors=Moss R, Munt B |title=Injection drug use and right sided endocarditis |journal=Heart |volume=89 |issue=5 |pages=577–81 |date=May 2003 |pmid=12695478 |pmc=1767660 |doi=10.1136/heart.89.5.577 |url=}}</ref> | |||
===Allergies=== | |||
A history of allergy to certain medications (such as [[penicillin]], [[heparin]], and anesthetic medications) and materials (such as latex or other prosthetic valve materials) is important for [[pre-operative clearance]] and planning on the choice of material for [[prosthetic valve]]. | |||
==Common symptoms== | |||
Clinical presentation of [[pulmonary regurgitation]] varies with the severity of the [[regurgitation]] and the [[right ventricle|right ventricular]] function.<ref name="pmid19038677">{{cite journal| author=Warnes CA, Williams RG, Bashore TM, Child JS, Connolly HM, Dearani JA et al.| title=ACC/AHA 2008 guidelines for the management of adults with congenital heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Develop Guidelines on the Management of Adults With Congenital Heart Disease). Developed in Collaboration With the American Society of Echocardiography, Heart Rhythm Society, International Society for Adult Congenital Heart Disease, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. | journal=J Am Coll Cardiol | year= 2008 | volume= 52 | issue= 23 | pages= e143-263 | pmid=19038677 | doi=10.1016/j.jacc.2008.10.001 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19038677 }} </ref><ref name="pmid6207619">{{cite journal| author=Shimazaki Y, Blackstone EH, Kirklin JW| title=The natural history of isolated congenital pulmonary valve incompetence: surgical implications. | journal=Thorac Cardiovasc Surg | year= 1984 | volume= 32 | issue= 4 | pages= 257-9 | pmid=6207619 | doi=10.1055/s-2007-1023399 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6207619 }} </ref><ref>{{cite book | last = Khavandi | first = Ali | title = Essential revision notes for the cardiology KBA | publisher = Oxford University Press | location = Oxford | year = 2014 | isbn = 978-0199654901 }} </ref><ref name="BouzasKilner2005">{{cite journal|last1=Bouzas|first1=Beatriz|last2=Kilner|first2=Philip J.|last3=Gatzoulis|first3=Michael A.|title=Pulmonary regurgitation: not a benign lesion|journal=European Heart Journal|volume=26|issue=5|year=2005|pages=433–439|issn=0195-668X|doi=10.1093/eurheartj/ehi091}}</ref>: | |||
*Isolated [[pulmonary regurgitation]] is usually asymptomatic and is an incidental finding on [[2D echo]] even when the [[regurgitation]] is severe. | *Isolated [[pulmonary regurgitation]] is usually asymptomatic and is an incidental finding on [[2D echo]] even when the [[regurgitation]] is severe. | ||
*Patients with chronic [[PR]] develop right [[heart failure]] and present with the following symptoms: | *Patients with chronic [[PR]] develop right [[heart failure]] and eventually left [[heart failure]] and present with the following symptoms: | ||
** | **Initial [[symptoms]] of chronic [[PR]] is a functional limitation of physical activity | ||
**[[Ankle edema]] or [[swelling of the feet]] and legs | **[[Ankle edema]] or [[swelling of the feet]] and legs | ||
**[[Dyspnea|Dyspnea on exertion]] | **[[Dyspnea|Dyspnea on exertion]]/ [[exercise intolerance]] (one of the early signs of [[heart failure]]). The manifestation is due to [[pulmonary edema]] in a [[patient]] with suboptimal [[heart|cardiac]] pumping function. | ||
**[[Fatigue]] | **[[Fatigue]] | ||
**[[Hemoptysis]] or frothy sputum | **[[Hemoptysis]] or frothy [[sputum]] | ||
**[[cough|Nocturnal cough]] | **[[cough|Nocturnal cough]] | ||
* | *At an early stage of [[RV]] dysfunction, the [[patients]] often fall in [[NYHA]] class 1 although [[symptoms]] may vary for a few [[patients]].<ref name="BouzasKilner2005">{{cite journal|last1=Bouzas|first1=Beatriz|last2=Kilner|first2=Philip J.|last3=Gatzoulis|first3=Michael A.|title=Pulmonary regurgitation: not a benign lesion|journal=European Heart Journal|volume=26|issue=5|year=2005|pages=433–439|issn=0195-668X|doi=10.1093/eurheartj/ehi091}}</ref> | ||
*Patients with [[arrythmias]] present with [[palpitations]], [[dizziness]], or an episode of [[syncope]].<ref name="pmid15640261">{{cite journal| author=Bouzas B, Kilner PJ, Gatzoulis MA| title=Pulmonary regurgitation: not a benign lesion. | journal=Eur Heart J | year= 2005 | volume= 26 | issue= 5 | pages= 433-9 | pmid=15640261 | doi=10.1093/eurheartj/ehi091 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15640261 }} </ref><ref name="pmid7421291">{{cite journal| author=Wessel HU, Cunningham WJ, Paul MH, Bastanier CK, Muster AJ, Idriss FS| title=Exercise performance in tetralogy of Fallot after intracardiac repair. | journal=J Thorac Cardiovasc Surg | year= 1980 | volume= 80 | issue= 4 | pages= 582-93 | pmid=7421291 | doi= | pmc= | url= }} </ref> | *Patients with [[arrythmias]] present with [[palpitations]], [[dizziness]], or an episode of [[syncope]].<ref name="pmid15640261">{{cite journal| author=Bouzas B, Kilner PJ, Gatzoulis MA| title=Pulmonary regurgitation: not a benign lesion. | journal=Eur Heart J | year= 2005 | volume= 26 | issue= 5 | pages= 433-9 | pmid=15640261 | doi=10.1093/eurheartj/ehi091 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15640261 }} </ref><ref name="pmid7421291">{{cite journal| author=Wessel HU, Cunningham WJ, Paul MH, Bastanier CK, Muster AJ, Idriss FS| title=Exercise performance in tetralogy of Fallot after intracardiac repair. | journal=J Thorac Cardiovasc Surg | year= 1980 | volume= 80 | issue= 4 | pages= 582-93 | pmid=7421291 | doi= | pmc= | url= }} </ref> | ||
*Symptoms of the underlying [[disease]] process may also be present. | *[[Symptoms]] of the underlying [[disease]] process may also be present. | ||
==Associated symptoms== | |||
[[PR]] is a secondary disease and it is important to assess the causative [[lesion]]. Symptoms of the primary [[disease]] or [[disorder]] may include: | |||
*To read about the symptoms and history of [[TOF]], the repair of which is a common cause of PR, [[Tetralogy of fallot history and symptoms|click here]]. | |||
* | |||
==References== | ==References== | ||
Revision as of 22:43, 5 August 2020
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Pulmonic regurgitation Microchapters |
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Diagnosis |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Aravind Kuchkuntla, M.B.B.S[2]Aysha Anwar, M.B.B.S[3]
Overview
Clinical presentation of pulmonary regurgitation varies with the severity of the regurgitation and right ventricular dysfunction. Isolated pulmonary regurgitation is usually asymptomatic. However, patients with chronic PR may present with symptoms of heart failure such as ankle edema, swelling of feet or legs, dyspnea on exertion, fatigue, hemoptysis, nocturnal cough and palpitations.[1][2]
History
Patient history
Past medical history
Family history
A family history of TOF or autosomal dominant causes of PR such as Marfan syndrome may be helpful in determining the cause of the disease.
Social history
- Smoking: PAH a common cause of PR. Tobacco smoking is a risk factor for developing PAH.[3] Although, no direct correlation between smoking and PR has been reported, a history of smoking or associated COPD may be required for pre-operative clearancein case a corrective surgery is planned.
- Intravenous drug use (recreational): Infective endocarditis although an uncommon cause of PR is overwhelmingly a disease of IV drug abuse. In an urban university hospital NJ, USA, s prospective study reported that 13% of IV injection users with fever have echocardiographic evidence of IE.[4] Although pulmonary valve involvement is rare, but cases of PR among IV drug users have been reported.[5][6]
Allergies
A history of allergy to certain medications (such as penicillin, heparin, and anesthetic medications) and materials (such as latex or other prosthetic valve materials) is important for pre-operative clearance and planning on the choice of material for prosthetic valve.
Common symptoms
Clinical presentation of pulmonary regurgitation varies with the severity of the regurgitation and the right ventricular function.[1][2][7][8]:
- Isolated pulmonary regurgitation is usually asymptomatic and is an incidental finding on 2D echo even when the regurgitation is severe.
- Patients with chronic PR develop right heart failure and eventually left heart failure and present with the following symptoms:
- Initial symptoms of chronic PR is a functional limitation of physical activity
- Ankle edema or swelling of the feet and legs
- Dyspnea on exertion/ exercise intolerance (one of the early signs of heart failure). The manifestation is due to pulmonary edema in a patient with suboptimal cardiac pumping function.
- Fatigue
- Hemoptysis or frothy sputum
- Nocturnal cough
- At an early stage of RV dysfunction, the patients often fall in NYHA class 1 although symptoms may vary for a few patients.[8]
- Patients with arrythmias present with palpitations, dizziness, or an episode of syncope.[9][10]
- Symptoms of the underlying disease process may also be present.
Associated symptoms
PR is a secondary disease and it is important to assess the causative lesion. Symptoms of the primary disease or disorder may include:
- To read about the symptoms and history of TOF, the repair of which is a common cause of PR, click here.
References
- ↑ 1.0 1.1 Warnes CA, Williams RG, Bashore TM, Child JS, Connolly HM, Dearani JA; et al. (2008). "ACC/AHA 2008 guidelines for the management of adults with congenital heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Develop Guidelines on the Management of Adults With Congenital Heart Disease). Developed in Collaboration With the American Society of Echocardiography, Heart Rhythm Society, International Society for Adult Congenital Heart Disease, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons". J Am Coll Cardiol. 52 (23): e143–263. doi:10.1016/j.jacc.2008.10.001. PMID 19038677.
- ↑ 2.0 2.1 Shimazaki Y, Blackstone EH, Kirklin JW (1984). "The natural history of isolated congenital pulmonary valve incompetence: surgical implications". Thorac Cardiovasc Surg. 32 (4): 257–9. doi:10.1055/s-2007-1023399. PMID 6207619.
- ↑ Schiess R, Senn O, Fischler M, Huber LC, Vatandaslar S, Speich R, Ulrich S (November 2010). "Tobacco smoke: a risk factor for pulmonary arterial hypertension? A case-control study". Chest. 138 (5): 1086–92. doi:10.1378/chest.09-2962. PMID 20472864.
- ↑ Weisse AB, Heller DR, Schimenti RJ, Montgomery RL, Kapila R (March 1993). "The febrile parenteral drug user: a prospective study in 121 patients". Am. J. Med. 94 (3): 274–80. doi:10.1016/0002-9343(93)90059-x. PMID 8452151.
- ↑ Hecht SR, Berger M (October 1992). "Right-sided endocarditis in intravenous drug users. Prognostic features in 102 episodes". Ann. Intern. Med. 117 (7): 560–6. doi:10.7326/0003-4819-117-7-560. PMID 1524330.
- ↑ Moss R, Munt B (May 2003). "Injection drug use and right sided endocarditis". Heart. 89 (5): 577–81. doi:10.1136/heart.89.5.577. PMC 1767660. PMID 12695478.
- ↑ Khavandi, Ali (2014). Essential revision notes for the cardiology KBA. Oxford: Oxford University Press. ISBN 978-0199654901.
- ↑ 8.0 8.1 Bouzas, Beatriz; Kilner, Philip J.; Gatzoulis, Michael A. (2005). "Pulmonary regurgitation: not a benign lesion". European Heart Journal. 26 (5): 433–439. doi:10.1093/eurheartj/ehi091. ISSN 0195-668X.
- ↑ Bouzas B, Kilner PJ, Gatzoulis MA (2005). "Pulmonary regurgitation: not a benign lesion". Eur Heart J. 26 (5): 433–9. doi:10.1093/eurheartj/ehi091. PMID 15640261.
- ↑ Wessel HU, Cunningham WJ, Paul MH, Bastanier CK, Muster AJ, Idriss FS (1980). "Exercise performance in tetralogy of Fallot after intracardiac repair". J Thorac Cardiovasc Surg. 80 (4): 582–93. PMID 7421291.