A 37 y/o F seen by you for evaluation of dyspnea. Which of the following physical findings would fit the Dx of idiopathic pulmonary arterial hypertension?
a) Elevated neck veins, normal S1 and S2, II/VI diastolic blowing murmur heard at the right upper sternal border
b) Elevated neck veins; singular, loud S2; II/VI systolic murmur left lower sternal border
c) Elevated neck veins; loud, fixed, split S2; III/VI systolic murmur left lower sternal border
d) Elevated neck veins, expiratory splitting of S2, II/VI harsh systolic murmur left upper sternal border
e) Elevated neck veins, barrel chest, prolonged expiratory phase
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Dyspnea and barrel chest- emphysema, COPD. Pulmonary vascular remodelling - increased pulmonary arterial pressure
They may develop pulmonary hypertension in chronic states. Over a period of time, the RV volume increase, and the fluid back up into the JVD, hence increased JVD - Elevated neck veins.
The right ventricle has to works harder to expel the blood to the pulmonary circulation, because of the increased volume- So possible RVD hypertrophy.
E
Dyspnea and barrel chest- emphysema, COPD. Pulmonary vascular remodelling - increased pulmonary arterial pressure
They may develop pulmonary hypertension in chronic states. Over a period of time, the RV volume increase, and the fluid back up into the JVD, hence increased JVD - Elevated neck veins.
The right ventricle has to works harder to expel the blood to the pulmonary circulation, because of the increased volume- So possible RV concentric hypertrophy.
E
D- wide splitting of s2/p2 on expiration at left upper sternal border can be Pulmonary stenosis and also Pulmonary hypertension
so it might be D. cause the word Idiopathic. Cause E might not be idiopathic since its caused by COPD
The 1st thing that you’re going to notice PH is that there would be a loud P2 (PH that closing very harshly the door of pulmonic valve) louder than 1st sound at the cardiac base. You may also be going to note the murmur of tricuspid regurgitation (which u can recall hollow systolic) & also can have RV heave…
If I would ask you exam the pat who got PH, you would tell me in initial finding I found -> ↑ intensity/pulmonic component/S2 (may be palpable)
The 2nd heart sound is narrowly split or SINGLE in pat with preserved RV function
In idiopathic pulmonary arterial hypertension: There is NO asso congenital lesion (such ASD).
ASD music components of the 2nd heart sound, aortic & pulmonic valve closure, do not alter their timing with respect to respiratory cycle and are ALWAYS “widely split” -> & thus are described as "fixed split".
In idiopathic pulmonary arterial hypertension, the components of the second heart sound are nearly superimposed & loud; often there is little respiratory variation.
The soft systolic murmur @ the L lower sternal border of tricuspid regurgitation is nearly ALWAYS present in PH of all whatever the case etiology maybe.
B correct here.
Regard to your post on forum the best source for heart sound by Dr. Salvatore Mangionebe you can get his 2nd/ed for B&N called "Secrets Heart & Lung Sounds Audio Workshop" they gone give access code u can use & its cheap.
#1 in my opionin
You also can search some of his lecture on YT.
GL
Thanks for the recommendation.
Great discussion, i always miss it ):
at what time, you usually post Dr robin hood }: @ Cardio69?
@cross most welcome.
@mle99 lol, time varies. Are you around now?