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.
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Authors and Reviewers
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Heart sounds by Dr. Jonathan Keroes, MD and David Lieberman, Developer, Virtual Cardiac Patient.
- Lung sounds provided by Diane Wrigley, PA
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Heart sounds mentorship by W. Proctor Harvey, MD
- Reviewed by Dr. Barbara Erickson, PhD, RN, CCRN.
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Last Update: 11/10/2022
Sources
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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
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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
Laennec Publishing; 1st edition (January 1, 2009)
How to use a stethoscope
