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Pulmonary Arterial Hypertension.

Pulmonary Arterial Hypertension

Auscultate and diagnose

Pulmonary Arterial Hypertension

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 emphasis will be placed on detecting abnormal heart sounds in the cardio-pulmonary circulation.


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.

Course Contributors

Heart and Lung Sounds Contributors: Dr. Jonathan Keroes, MD (Johns Hopkins), Cardiologist (ret.), David Lieberman, Heart Sound Simulation Consultant; Diane Wrigley, Physician Assistant and national CME instructor. Editorial review by Dr. Barbara Erickson, Author and Editor.
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