THE CONTEXT
Tricuspid stenosis produces signs of impaired right ventricular filling and right heart failure, although associated mitral and aortic valve disease may dominate the symptoms. The passage also lists causes of tricuspid regurgitation.
Symptoms and venous findings
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Tricuspid stenosis may cause hepatic discomfort and peripheral oedema as manifestations of right heart failure.
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The jugular venous pressure is raised, with a prominent a wave and a slow y descent caused by loss of normal rapid right ventricular filling.
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Right heart failure may produce hepatomegaly with presystolic pulsation corresponding to a large a wave, ascites and peripheral oedema.
Murmur and diagnostic confirmation
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A mid-diastolic murmur is best heard at the lower left or right sternal border.
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The murmur is generally higher pitched than that of mitral stenosis and becomes louder during inspiration.
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Doppler echocardiography confirms the diagnosis and shows appearances similar to those of rheumatic mitral stenosis.
Causes of tricuspid regurgitation
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Primary causes include rheumatic heart disease, endocarditis particularly in intravenous drug users, and Ebstein congenital anomaly.
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Secondary causes include right ventricular failure, right ventricular infarction and pulmonary hypertension secondary to chronic pulmonary disease.