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32 Possible Causes for Impaired Exercise Tolerance, Prominent A-Wave, Pulmonary Systolic Murmur

  • Eisenmenger Syndrome

    ECG of Eisenmenger syndrome Usually there is right ventricular hypertrophy with prominent P waves.[remedyland.com] Patients with pre-tricuspid shunts were older, had higher BNP concentrations and lower exercise tolerance compared to patients with post-tricuspid shunts.[ncbi.nlm.nih.gov] Elevated jugular venous pressure and prominent "v" wave in right heart failure and severe tricuspid regurgitation.[ncbi.nlm.nih.gov]

  • Patent Ductus Arteriosus

    Course and Complications  Ejection systolic murmur at birth (due to pulmonary hypertension)  continuous murmur after a few weeks  Development of Pulmonary arterial hypertension[slideshare.net] A heart murmur occurs in the pulmonary area; the murmur may be continuous, systolic with a short diastolic component, or only systolic, depending on the pulmonary artery pressure[msdmanuals.com]  diastolic component lost  ejection systolic murmur  Severe PAH  rt to lft shunt  disappearance of the murmur and appearance of differential cyanosis 15.[slideshare.net]

  • Pulmonary Valve Stenosis

    ECG of pulmonary valve stenosis Electrical axis deviation to right or right ventricular hypertrophy, prominent P wave.[remedyland.com] Sixteen patients were asymptomatic with pulmonary systolic murmurs, although 6 patients presented with dyspnea.[ncbi.nlm.nih.gov] With increasing right ventricular hypertrophy, right ventricular compliance decreases with a resultant increase in end-diastolic pressure and with prominent a waves in the[emedicine.medscape.com]

  • Atrial Septal Defect

    In sinus venosus ASD, it shows left axis deviation and a negative P wave in lead III.[symptoma.com] MurmursPulmonary ejection systolic murmur – Increased pulmonary flow • Tricuspid murmur – is heard over left sternal edge louder on inspiration • Graham-Steell murmur[slideshare.net] There is further turbulent flow into the pulmonary artery causing the systolic murmur.[easyauscultation.com]

  • Cor Pulmonale

    On electrocardiogram, there was right axis deviation, p-pulmonale, features of right ventricular hypertrophy along with presence of prominent Q waves in leads II, III and[ijem.in] Split second heart sound with loud pulmonary component. Systolic ejection murmur with a sharp ejection click over the pulmonary artery (advanced sign).[patient.info] The most typical ECG findings in emphysema are: Rightward shift of the P wave axis with prominent P waves in the inferior leads and flattened or inverted P waves in leads[lifeinthefastlane.com]

  • Pulmonary Hypertension

    […] for conditions that can produce pulmonary hypertension (murmurs, collagen disease, valve pathology, VTE, OSA, alcohol consumption, chronic respiratory disease) Examination prominent[lifeinthefastlane.com] Clinical signs include right ventricular (parasternal) heave, a loud pulmonary second heart sound, murmur of pulmonary regurgitation, systolic murmur of tricuspid regurgitation[patient.info] […] capacity, reduce exercise tolerance, 87 induce iron deficiency, 24 and increase the risk of stroke. 88 If phlebotomy is performed, iron status should be monitored closely[doi.org]

  • Congestive Heart Failure

    In 893 patients aged from 40 to 102 years, we simultaneously recorded electrocardiogram, phonocardiogram, and jugular venous pulse wave.[ncbi.nlm.nih.gov] The characteristic apical systolic murmur may be absent in patients with severe MR, due to the abrupt and severe elevation of left atrial pressure.[doi.org] The impairment of exercise tolerance indicated by NYHA classification was markedly improved by PD for both groups.[ncbi.nlm.nih.gov]

  • Heart Failure

    In patients with considerable tricuspid regurgitation, a prominent systolic pulsation of the liver, attributable to an enlarged right atrial V wave, is often noted.[emedicine.medscape.com] The characteristic apical systolic murmur may be absent in patients with severe MR, due to the abrupt and severe elevation of left atrial pressure.[doi.org] Numerous mechanisms unrelated to hemodynamic dysfunction may underlie impaired exercise tolerance in patients with chronic heart failure.[doi.org]

  • Mitral Valve Insufficiency

    Inspection of the jugular venous pulsations may reveal a prominent “A wave,” attributable to vigorous atrial contraction or a prominent V wave due to tricuspid regurgitation[healio.com] The cardinal physical finding is a mitral systolic murmur.[ncbi.nlm.nih.gov] He is in chronic atrial fibrillation (AF), his neck veins are distended with prominent V waves, and he has an enlarged pulsating liver and severe peripheral edema.[onlinejacc.org]

  • Restrictive Cardiomyopathy

    Examination: JVP 14 cm, prominent V waves and exaggerated Y descent. Hepatosplenomegally, peripheral oedema.[scmr.org] Presentation Usually presents with heart failure but normal systolic function: dyspnoea, fatigue, loud third heart sound, pulmonary oedema, murmurs due to valve incompetence[patient.info] His ECG showed prominent P-waves in all leads consistent with bi-atrial enlargement. His mother (III-17) had symptoms of heart failure from the age of 29 years.[jci.org]

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