Welcome to another installment of our Sunday Funday Webinar series!
If you're a Physician Assistant (PA) student or a practicing PA eager to deepen your understanding of pulmonary stenosis and pulmonary regurgitation, you've come to the right place.
In today's session, we're diving into these complex cardiovascular conditions, exploring their clinical presentations, and offering diagnostic clues that can be game-changers as you prepare for your PANCE, PANRE, and EOR Exams.
Webinar Replay: Pulmonary Stenosis and Pulmonary Regurgitation
What You Will Learn in This Webinar
- Physiology of Pulmonary Stenosis and Pulmonary Regurgitation
- Clinical Presentations
- Diagnostic Clues
- Test-taking Strategies for PANCE
Physiology of Pulmonary Stenosis
Pulmonary stenosis is a condition where the pulmonary valve is narrowed, causing a backup of blood flow into the right ventricle. This leads to right ventricular hypertrophy and can even cause right axis deviation and bundle branch block.
Key Points:
- Shortness of breath, angina, and syncope: These are common presentations associated with pulmonary stenosis.
- Systolic ejection murmur: Occurs in the second intercostal space on the left side.
- Split S2: The pulmonic valve is late to open, causing a split in the second heart sound.
- Right ventricular hypertrophy: Due to the backflow of blood.
- Right Bundle branch block: Due to stretching of the "wires."
Diagnostic Clues
- Inspiration is going to make it sound louder: The pulmonic valve is on the right side, so inspiration will make the murmur of pulmonic stenosis sound louder, and the murmur of pulmonic stenosis will go away with expiration.
- Standing and Valsalva make the murmur go away: Standing and Valsalva are low-volume maneuvers, and it goes away.
- Squatting makes the murmur louder: Squatting is party, and squatting makes the murmur of pulmonic stenosis sound louder.
- No change of the murmur with handgrip: Handgrip challenges the aortic valve and does not affect the murmur of pulmonary stenosis.
Physiology of Pulmonary Regurgitation
In pulmonary regurgitation, the pulmonary valve remains open, causing issues during diastole. This leads to a diastolic murmur that starts in the second intercostal space and radiates down towards the apex.
Key Points:
- Diastolic Murmur: Occurs in the second intercostal space on the left side.
- Shortness of Breath: Common symptom, worsens with exertion.
- Right Ventricular Hypertrophy: Can occur over time.
Diagnostic Clues
- Inspiration: Makes right-sided murmurs louder. The pulmonic valve is on the right side, so inspiration will make the murmur of pulmonic regurgitation sound louder.
- Expiration: Makes left-sided murmurs louder. The murmur of pulmonic regurgitation will go away with expiration.
- Squatting: Increases the volume of all murmurs. Squatting makes the murmur of pulmonic regurgitation sound louder.
- Hand Grip: Challenges the aortic valve but not the pulmonic valve and does not affect the murmur of pulmonary regurgitation.
Test-taking Strategies for the PANCE
Understanding the nuances of pulmonary stenosis and pulmonary regurgitation is crucial for clinical practice and your summative exams. Combine this with effective test-taking strategies, and you will set on exam day.
Smarty PANCE Content Blueprint Review
Pulmonary valve stenosis and regurgitation are covered under The PANCE Cardiology Blueprint under the category of Valvular Disorders.
These valvular conditions were also covered as part of an exceptional five-part podcast series recorded with Joe Gilboy PA-C, all about cardiac murmurs. Click here to check out episode 93 - Murmurs Made Incredibly Easy, which covers pulmonary valve stenosis and regurgitation. You can also take our podcast to go by subscribing to The Audio PANCE and PANRE Podcast.
Thank you for joining us for another Sunday Funday Webinar! You can sign up for future events and find past recordings of all our Sunday Funday Webinars in our FREE Smarty PANCE Member Community and by subscribing to our FREE Event Replays.
Have a great day, and happy studying!
Warmly,
Stephen Pasquini PA-C
