Less common Valvular Lesions

Question 1

What are the signs of Tricuspid Regurgitation

Answer 1

End of the bed:
Peripheral oedema
Jaundice

Neck:
Giant V wave and prominent Y descent in JVP

Face:
Jaundice - Yellow Sclera

Chest:
Pan-systolic Murmur - Lower sternal edge during inspiration
RV heave

Abdomen:
Pulsatile Hepatomegally
Ascites

Question 2

What are the signs of Tricuspid Stenosis

Answer 2

Hands:
Irregular pulse as commonly in AF

Neck:
Giant A wave and slow Y descent of JVP

Chest:
Opening Snap
Early Diastolic Murmur - Left sternal edge during inspiration

Question 3

What are the signs of Pulmonary Regurgitation

Answer 3

Chest:

Decrescedno murmur in early diastole - left sternal edge

Question 4

What are the signs of Pulmonary Stenosis

Answer 4

Neck:
Prominent A wave in JVP

Face:
Dysmorphic Faecies - Only in congenital disease

Chest:
Ejection click/sytolic murmur radiating to left shoulder
RV heave
Widely split s2

Question 5

What will you find/ask about in a history of right sided (Tricuspid/Pulmonary) valve lesions?

Answer 5

Symptoms:
Peripheral Oedema
Hepatic Pain on exertion - hepatic congestion
Ascites
Oedema
Fatigue

Risk Factors:
Use of IV drugs can go onto infect right sided valve infections

Cardiac History Questions to ask:
Chest pain
Shortness of breath (exercise tolerance, orthopnoea, paroxysmal nocturnal dyspnoea)
Cough - Sputum/Haemoptysis  
Palpitations - Tap out the rhythm 
Oedema 
Syncope
Cardiovascular history- Stroke, PVD, smoking, high cholesterol, high blood pressure, diabetes, family history of early cardiac death. 

Differentials