Pulmonic Regurgitation

  • There are a variety of causes of pulmonic regurgitation, including pulmonary hypertension (so-called Graham-Steell murmur), infective endocarditis, and congenital abnormalities of the cusps (eg, bicuspid valve).
  • The diastolic murmur of pulmonic regurgitation is similar in quality to aortic regurgitation in that it is early and decrescendo. It is best heard in the left upper sternal border, but like AR, may be loudest over the 4th intercostal space. Unlike AR, the intensity with inspiration (Carvallo’s sign).
  • Associated findings include pulmonary artery pulsation, pulmonic ejection click, and an ejection murmur, all of which are best appreciated over the left upper sternal border.

Patient 1:

This patient has

Pulmonic Regurgitation 

Annotated

Patient 2

This is an older man with multiple valvulopathies, including severe mitral valve regurgitation, moderate aortic stenosis, and moderate pulmonic insufficiency.

 

Patient 3:

This is a middle age man with a history of pulmonic valve endocarditis from IV drug use, now with moderate pulmonic insufficiency.

 

Patient 4: