Right Heart Valve Disease

Question 1

What sort of murmur is tricuspid regurgitation?

Answer 1

pansystolic

Question 2

What sort of murmur is tricuspid stenosis?

Answer 2

mid/late diastolic

Question 3

What sort of murmur is pulmonary stenosis?

Answer 3

ejection systolic

Question 4

What sort of murmur is pulmonary regurgitation?

Answer 4

early diastolic

Question 5

What are the causes of TR?

Answer 5

1. Congenital e.g. Ebstein’s abnormality
2. Rheumatic vasculitis
3. Endocarditis
4. Scarring from carcinoid heart disease
5. Rheumatoid arthritis
6. Pulmonary hypertension

Question 6

What are RF for TR?

Answer 6

1. Left sided heart failure
2. Rheumatic heart disease
3. Permanent pacemaker
4. Endocarditis
5. Carcinoid heart disease

Question 7

What are symptoms of TR?

Answer 7

1. Fatigue and effort intolerance
2. Dyspnoea
3. Palpitations
4. Peripheral oedema

Question 8

What are the signs of TR?

Answer 8

1. V waves and Y waves in jugular venous pulse
2. Irregular hear rhythm: AF or atrial flutter
3. Parasternal systolic murmur
4. Increased systolic murmur on inspiration (Carvallo’s sign)
5. RV heave
6. Pulsatile hepatomegaly

Question 9

What Ix is done for TR?

Answer 9

1. Transthoracic or transoesophageal echo
2. ECG
3. CXR

Question 10

What bloods are done for TR?

Answer 10

1. LFTs
2. Serum Urea and Creatinine
3. FBC

Question 11

What is the management of TR?

Answer 11

• treat underlying cause
• valve repair
• Diuretics for systemic congestion

Question 12

What are complications of TR?

Answer 12

1. Atrial arrhythmia
2. Advanced liver disease
3. AV block
4. MI
5. Prosthetic valve thrombosis
6. Prosthetic valve endocarditis

Question 13

What are the causes of tricuspid stenosis?

Answer 13

1. Rheumatic fever
2. Congenital
3. Infective endocarditis

Question 14

What are symptoms of TS?

Answer 14

1. Fatigue
2. Ascites
3. oedema

Question 15

What are signs of TS?

Answer 15

1. Giant a wave and slow y descent in JVP
2. Opening snap
3. Early diastolic murmur heard at left sternal edge in inspiration
4. AF can also occur

Question 16

What are causes of pulmonary stenosis?

Answer 16

1. Congenital (turners, noonan syndrome, Williams syndrome, fallots tetralogy, rubella)
2. Carcinoid syndrome
3. Rheumatic fever

Question 17

What are symptoms of pulmonary stenosis?

Answer 17

1. Dyspnoea
2. Fatigue
3. Oedema
4. Ascites

Question 18

What are signs in PS?

Answer 18

1. Prominent a wave in JVP

2. RV heave

Question 19

What are signs in mild PS?

Answer 19

1. ejection click
2. ejection systolic murmur that radiates to left shoulder
3. widely split stenosis

Question 20

What are signs in severe PS?

Answer 20

murmur becomes longer and obscures A2 and P2 becomes softer and may be inaudible

Question 21

What Ix is done for PS?

Answer 21

1. ECG
2. CXR
3. Cardiac catherterisation is diagnostic

Question 22

What does ECG show on PS?

Answer 22

1. RAD
2. P-pulmonale
3. RVH
4. RBBB
5. echo

Question 23

What does CXR show in PS?

Answer 23

prominent pulmonary arteries caused by post stenotic dilation

Question 24

What is the management of PS?

Answer 24

Pulmonary valvuloplasty or valvotomy

Question 25

What is the cause of pulmonary regurgitation?

Answer 25

any cause of pulmonary hypertension

Question 26

What are signs of pulmonary regurgitation?

Answer 26

1. Decrescendo murmur in early diastole at left sternal edge
2. Graham steel murmur is associated with mitral stenosis and pulmonary hypertension