1. How high does the pulmonary artery pressure have to be to produce a pulmonary regurgitation (PR) murmur?
ANS: It is usually at nearly systemic levels. Pulmonary regurgitation murmurs are rarely present with pulmonary artery pressures of below 80 mmHg systolic unless the main pulmonary artery is markedly dilated.
Note: A Graham Steell murmur is a PR murmur that is secondary to pulmonary hypertension.
2. How does the Graham Steell murmur differ from the AR murmur?
ANS: It may not differ, i.e., both are dominantly high-pitched and may be from grade l to 6. The Graham Steell murmur, however, often increases with inspiration and also increases with amyl nitrate, while AR decreases.
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