mitral/tri 3

Question 1

murmurs of tricuspid regurg

Answer 1

T murmur becomes louder with inspiration because inspiration increases venous to the right side of the heart

Question 2

Tricuspid regurgitation Physical exam findings

Answer 2

1. JVD with visible systolic “v” wave in 35-75% of patients
2. hepatosplenomegaly is present in 90% of pt but systolic pulsation of liver is noted inconsistently
3. classically the holosystolic murmur of tricuspid regurg is heard along the sternal border and increases in intensity with inspiration

Question 3

TR symptoms

Answer 3

1. fatigue from low CO
2. abdominal fullness
3. edema
4. palpitations (if atrial arrhythmia present)
5. hepatic congestion/dysfunction may occur due to elevated RA pressure

Question 4

TR tx:

Answer 4

1. if function TR, tx underlying cause of RV pressure/overload
2. medications: diuretics
3. surgery:
   a. tricuspid repair
   b. tricuspid replacement

Question 5

Tricuspid Regurgitation: Indications for surgery

Answer 5

1. Severe TR in pts undergoing left sided valve surgery
2. TV repair in pts with less severe TR with tricuspid annular dilation or evidence of right heart failure
3. Symptomatic severe TR unreponsive to medical therapy
4. Asymptomatic severe TR and progressive RV dilation or dysfunction

Question 6

tricuspid stenosis

Answer 6

1. rare
2. usually from rheumatic heart disease
3. murmur is similar to that of mitral stenosis but is heard closer to the sternum and intensifies with inspiration
4. symptoms include dyspnea and edema. often occurs simulatenously with mitral stenosis

Question 7

tricuspid stenosis etiology

Answer 7

1. rheumatic heart disease
2. congenital Ts
3. RA tumor
4. Carcinoid heart disease
5. endomyocardial fibrosis
6. valvular vegetations
7. extracardiac tumors

Question 8

tricuspid stenosis treatment:

Answer 8

1. meds: diuretics
2. TV surgery:
   a. severe TS at time of operation for Left sided valve disease
   b. isolated, symptomatic severe TR