Effect of the Valsalva Maneuver on the Second Heart Sound.

The Valsalva maneuver should be incorporated into the routine of auscultation even when a murmur is absent. Valsalva release affects the second heart sound. It is particularly helpful during detailed, non-perfunctory auscultation in patients with bundle branch block.

Assessment of pulmonary arterial hypertension in patients with systemic sclerosis: comparison of noninvasive tests with results of right-heart catheterization.

Objective: Pulmonary hypertension (PH) is an ominous complication in patients with scleroderma (systemic sclerosis, SSc). We compared noninvasive assessment of PH with pulmonary artery (PA) pressures obtained by right-heart catheterization (RHC).

Methods: Forty-nine patients with SSc were evaluated for suspected PH based on clinical findings, progressive dyspnea, and pulmonary function tests (PFT).

Practical cardiac auscultation.

This article focuses on the practical use of the stethoscope. The art of the cardiac physical examination includes skillful auscultation. The article provides the author's personal approach to the patient for the purpose of best hearing, recognizing, and interpreting heart sounds and murmurs.

Pulmonary vein edema in a patient undergoing coronary artery bypass graft surgery and concomitant radiofrequency ablation for chronic atrial fibrillation.

The syndrome of pulmonary vein stenosis characterized by pulmonary hypertension, dyspnea on exertion, and right heart failure, is a well-described complication of percutaneous ablation approaches, but has not been described with surgical approaches. We describe the case of a patient who developed localized edema at the pulmonary vein-left atrial junction after undergoing intraoperative radiofrequency ablation for chronic atrial fibrillation as part of CABG for severe triple vessel disease. The pulmonary vein edema resolved within 10 months suggesting that it may be a clinically silent and self-resolving phenomenon.