Pulmonary regurgitation and the Graham Steell murmur
THE CONTEXT
Pulmonary regurgitation is rare in isolation and is usually associated with pulmonary artery dilatation caused by pulmonary hypertension.
Associations
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Pulmonary regurgitation may complicate mitral stenosis.
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Associated pulmonary hypertension may arise from other left-sided heart disease, primary pulmonary vascular disease or Eisenmenger syndrome.
Auscultation and clinical significance
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Pulmonary regurgitation complicating mitral stenosis may produce the Graham Steell murmur: an early diastolic decrescendo murmur at the left sternal border.
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This murmur is difficult to distinguish from that of aortic regurgitation.
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Trivial pulmonary regurgitation is frequent in normal individuals and has no clinical significance.