Internal Medicine

0521779407-17 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:19

Pulmonary Stenosis (PS) 1249

PULMONARY STENOSIS (PS)

JUDITH A. WISNESKI, MD

history & physical

Etiology

■Congenital

■Carcinoid syndrome

History

■Fatigue

■Syncope – usually with exertion

■Chest pain – similar to angina

Signs & Symptoms

■Harsh systolic ejection murmur in pulmonic area

■Systolic click varies with respiration

■P2 increased (mild/moderate)

■P2 absent (severe or calcified valve)

■Right ventricular lift

■Signs of right ventricular failure

➣Elevated JVP

➣Hepatomegaly, ascites

➣Peripheral edema

tests

■ECG

➣Right ventricular hypertrophy

■Chest X-Ray

➣Post-stenotic dilation of pulmonary arteries

➣Calcifications in pulmonic valve (adults)

➣Enlarged right ventricule

➣Enlarged right atrium (severe)

■Echo/Doppler

➣Doming of pulmonic valve

➣Quantitate gradient across pulmonic valve

■Cardiac Catheterization

➣Measure gradient across pulmonic valve

➣Right ventricular and right atrial pressures elevated

➣Low cardiac output (severe)