normal pulmonary vascular resistance

Last reviewed 06/2020

Symptoms include:

  • dyspnoea - there is a progression of symptoms through the spectrum of increasing exertional dyspnoea, paroxysmal nocturnal dyspnoea, orthopnoea and finally pulmonary oedema. The progression of these symptoms reflects a gradual elevation in left atrial pressure. These features are aggravated by the increased blood volume of pregnancy or the tachycardia of atrial fibrillation

  • palpitations

  • haemoptysis - may be due to pulmonary infarction

Signs include:

  • pulse - small; may be irregular if atrial fibrillation

  • jugular venous pressure - normal

  • cardiac impulses - palpable mitral first sound - tapping beat of mitral stenosis

  • auscultation:
    • loud first heart sound unless reduced mobility of a calcified and fibrotic mitral valve
    • opening snaps - this is a high-pitched early diastolic sound. It is maximal internal to the apex
    • diastolic murmurs:
      • presystolic murmur - when in sinus rhythm a presystolic murmur following left atrial contraction
      • mid-diastolic murmur - this is a longer, low frequency, rumbling murmur. It is best heard at the apex with the bell. The tighter the stenosis the longer the murmur.