Pulmonic regurgitation diagnosis

Symptoms
In mild to moderate cases, pulmonic regurgitation is asymptompatic. In more severe pulmonic regurgitation, patients may develop right ventricular dilatation and systolic dysfunction. Patients with early right ventricular dysfunction are often categorized as NYHA class 1. At this stage, research suggests that diagnostic measures such as exercise testing may indicate varying levels of exercise intolerance. As right ventricular failure progresses, right ventricular dysfunction becomes more symptomatic. Symptoms may include: dyspnea on exertion, peripheral edema, chest pain and fatigue. Patients may also complain of palpitations, light-headedness, as well as frank syncope. Advanced or later symptoms include the development of ascites, right upper quadrant pain (as a result of hepatic distension), and early satiety.

Prior to the age of 40, symptom onset is rare. Patients over 40 may potentially develop symptoms of right heart failure and present the risk of sudden cardiac death.

Care should be paid to symptoms that might be associated with an underlying etiology of the pulmonic regurgitation.

Physical Examination
A low-pitched murmur is present which is usually best heard along the third or fourth intercostal spaces adjacent to the left sternal border. The murmur may be accentuated with inspiration. When the pulmonary artery systolic pressure exceeds 70 mm Hg, dilatation of the pulmonary artery ring may then result in Graham-Steell's murmur. This is a high-pitched, blowing decrescendo murmur heard best along the left parasternal region. Pulmonic regurgitation is associated with wide splitting of S2. A right-sided S3 may be audible and may also be accentuated with inspiration. Likewise, a right-sided S4 may also be audible and accentuated with inspiration.

Electrocardiogram
Right axis deviation. Both right ventricular hypertrophy and right bundle branch block may be present.

Chest X-Ray
Both an enlarged pulmonary artery and an enlarged right ventricle may be present.