Internal Medicine

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

Pulmonary Valve Insufficiency (PI) 1251

■P2 increased (pulmonary artery hypertension present)

■P2 absent (congenital)

■S2 wide split

■Right ventricular S3

■Signs of right ventricular failure

➣Elevated JVP

➣Hepatomegaly, ascites

➣Edema

tests

ECG

■Incomplete or complete RBBB

■Right ventricular hypertrophy (pulmonary artery hypertension

present)

■Right atrial abnormality

Chest X-Ray

■Pulmonary artery enlarged

■Right ventricle enlarged

■Right atrium enlarged

■Dilated superior vena cava and azygos veins (severe)

Echo/Doppler (most important)

■Detect pulmonary valve insufficiency

■Function and size of right ventricule

■Right atrial size

■Detect tricuspid insufficiency (TR) and assess pulmonary artery

pressure (TR secondary to dilation of right ventricular)

■If pulmonary artery hypertension present, assess other conditions

which may be responsible: left ventricular dysfunction, mitral

stenosis

differential diagnosis

■Aortic insufficiency

management

n/a

specific therapy

■Primary pulmonary valve insufficiency

➣Medical

Diuretics and digoxin

➣Surgery