Pulmonary Arterial Hypertension

Pulmonary arterial hypertension (PAH) is a vascular disease which results in increased pressure in the blood vessels that supply blood to the lungs. In this course we will focus on detecting abnormal heart sounds in the cardio-pulmonary circulation.

Symptoms

The symptoms of Pulmonary arterial hypertension are:

Syncope with exertion
Shortness of breath with exertion
Fatigue
Ankle edema
Chest pain

Auscultatory Signs of PAH

The signs of Pulmonary Arterial Hypertension are heard at the following auscultatory areas:

2LICS (second left intercostal space)
3LICS (third left intercostal space)
LLSB (left lower sternal border)
RLSB (right lower sternal border)

The right ventricular third and fourth heart sounds are only heard with inspiration and only at the RLSB.

The murmur of tricuspid regurgitation increases in intensity and is best heard at the LLSB. It can also be heart at the RLSB.

The murmur of pulmonic insufficiency (the Graham Steel murmur) increases with intensity with full expiration and is best heard at the 3LICS (Erb's Point). It can also be heard at the 2LICS.

Please use good quality headphones or earphones during this course.

How To Use This Course

The patient cases provide a content for practicing exam and diagnostic skills. Each case consists of multiple pages which summarize patient history, heart and carotid artery sounds, lab results and diagnosis.

Sign-in to enable progress reports and certificates.

Authors and Reviewers

Heart sounds by Dr. Jonathan Keroes, MD and David Lieberman, Developer, Virtual Cardiac Patient.
Lung sounds provided by Diane Wrigley, PA
Heart sounds mentorship by W. Proctor Harvey, MD
Reviewed by Dr. Barbara Erickson, PhD, RN, CCRN.
Last Update: 11/10/2022

Sources

Heart Sounds and Murmurs Across the Lifespan (with CD) by Dr Barbara Ann Erickson
Publisher: Mosby
ISBN-10: 0323020453; ISBN-13: 978-0323020459
Heart Sounds and Murmurs: A Practical Guide with Audio CD-ROM 3rd Edition
Elsevier-Health Sciences Division
Barbara A. Erickson, PhD, RN, CCRN
Heart and Lung Sounds Reference Guide
PracticalClinicalSkills.com
Heart Sounds Made Easy with CD-ROM: (with CD-ROM) 2nd Edition
Anthony P. Salmon
ISBN-13: 978-0443069079
NCBI Review of Heart Sounds and Murmurs: A Practical Guide
The Virtual Cardiac Patient: A Multimedia Guide to Heart Sounds And Murmurs Jonathan Keroes, David Lieberman
Publisher: Lippincott Williams & Wilkin)
ISBN-10: 0781784425; ISBN-13: 978-0781784429
Ventricular Function Curves in the Exercising Dog
JONATHAN KEROES , ROGER R. ECKER , and ELLIOT RAPAPORT
Circulation Research, Vol. 25, No. 5
Electrocardiographic changes associated with ritodrine-induced maternal tachycardia and hypokalemia American Journal of Obstetrics Gynecology, VOLUME 154, ISSUE 4, P921-923, APRIL 01, 1986
Susan K Hendricks, MD, Jonathan Keroes, MD, Michael Katz, MD
The_Virtual_Cardiac_Patient_A_Multimedia_Guide_to_Heart_Sounds_and_Murmurs A Multimedia Guide to Heart Sounds and Murmurs
January 2007 JAMA The Journal of the American Medical Association 297(2):217-218
DOI:10.1001/jama.297.2.217. M. Saleem Seyal, MD, Reviewer
Clinical Heart Disease W Proctor Harvey, MD

How to use a stethoscope