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10 Possible Causes for Prominent A-Wave, Systolic Thrill at Lower Left Sternal Border

  • Patent Ductus Arteriosus

    Donohue syndrome, a rare autosomal recessive disorder, is associated with the mutation of the insulin receptor gene in the short arm of the 19th chromosome. It is very rare that a syndrome of insulin resistance resembles Donohue syndrome with patent ductus arteriosus. A 14-year-old girl, whose parents were[…][ncbi.nlm.nih.gov]

  • Ventricular Septal Defect

    3 to 4/6 holosystolic murmur (with or without thrill) at the lower left sternal border; this murmur is usually audible within the first few days of life (see table Heart[msdmanuals.com] Muscular defects can be heard along the lower left sternal border and may vary in intensity as the defect size changes with muscular contraction throughout systole.[circ.ahajournals.org] Small VSDs typically produce murmurs ranging from a grade 1 to 2/6 high-pitched, short systolic murmur (due to tiny defects that actually close during late systole) to a grade[msdmanuals.com]

  • Aortic Valve Stenosis

    The jugular venous pulse may show prominent a waves reflecting reduced right ventricular compliance consequent to hypertrophy of the interventricular septum.[emedicine.medscape.com] "a" wave (Bernheim effect).[emedicine.medscape.com] This is probably due to the bulging of the interventricular septum into the right ventricle, with impedance in filling, elevated jugular venous pressure, and a prominent venous[emedicine.medscape.com]

  • Tricuspid Valve Insufficiency

    Physical Examination Findings on cardiovascular examination in patients with tricuspid regurgitation include the following: S 3 gallop Jugular venous distention with a prominent[emedicine.medscape.com] In severe TR, a right jugular venous thrill may be palpable, as may systolic hepatic pulsation and an RV impulse at the left lower sternal border.[merckmanuals.com] Jugular venous pressure is elevated with a prominent systolic 'v' wave. Right ventricular impulse is hyperdynamic and may be thrusting in quality.[patient.info]

  • Large Ventricular Septal Defect

    3 to 4/6 holosystolic murmur (with or without thrill) at the lower left sternal border; this murmur is usually audible within the first few days of life (see table Heart[merckmanuals.com] Small VSDs typically produce murmurs ranging from a grade 1 to 2/6 high-pitched, short systolic murmur (due to tiny defects that actually close during late systole) to a grade[merckmanuals.com]

  • Apical Myocardial Infarction

    […] and transient and they are less prominent when haemodynamic status is corrected.[ncbi.nlm.nih.gov] This murmur is loudest along the lower left sternal border and is associated with a palpable parasternal systolic thrill. RV and LV S3 gallops are common.[emedicine.medscape.com] In cases with biventricular infarction, Q waves become deep and R waves are small, R/Q ratio being less than 2.5. [ 18, 19 ] In PE ECG, changes are frequently non–specific[ncbi.nlm.nih.gov]

  • Right Ventricular Hypertrophy

    Q waves simulating an IMI appear in leads 2,3, and aVF.[wikidoc.org] 3 to 4/6 holosystolic murmur (with or without thrill) at the lower left sternal border; this murmur is usually audible within the first few days of life (see table Heart[merckmanuals.com] […] in lateral (I, aVL, V5-6) leads tall, prominent R waves in lead V1 may be masked in the presence of COPD Radiographic features Plain radiograph Frontal view demonstrates:[radiopaedia.org]

  • Biventricular Hypertrophy

    ST elevation in the right precordial leads V1-3 (“discordant” to the deep S waves). Prominent U waves (proportional to increased QRS amplitude).[litfl.com] 3 to 4/6 holosystolic murmur (with or without thrill) at the lower left sternal border; this murmur is usually audible within the first few days of life (see table Heart[msdmanuals.com] Conversely, in the so-called diastolic overload pattern, the QRS changes are relatively more prominent than the ST-T wave changes.[frca.co.uk]

  • Tetralogy of Fallot

    Additionally, right atrial enlargement is manifested by prominent P waves in V1 (*). Right ventricular hypertrophy is demonstrated by a rightward deviated axis.[pedclerk.bsd.uchicago.edu] Systolic thrill at the lower left sternal border. Aortic ejection click.[patient.info] The electrocardiogram will demonstrate right axis deviation and prominent right ventricular forces, with large R waves in the anterior precordial leads and large S waves in[ncbi.nlm.nih.gov]

  • Multiple Ventricular Septal Defects

    Electrocardiography showed prominent R waves in right sided chest leads. Chest radiograph showed normal cardiac size with normal pulmonary flow.[heartviews.org] A localized harsh, holosystolic murmur which is best heard at the lower left sternal border, detected after 4-8 weeks of age or later.[medicaljoyworks.com] Hyperdynamic precordium: parasternal lift and apical thrust with a systolic thrill. In large defects. The volume overload causes ventricular dilatation and remodeling.[medicaljoyworks.com]

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