Right Heart Valve Disease Flashcards
What sort of murmur is tricuspid regurgitation?
pansystolic
What sort of murmur is tricuspid stenosis?
mid/late diastolic
What sort of murmur is pulmonary stenosis?
ejection systolic
What sort of murmur is pulmonary regurgitation?
early diastolic
What are the causes of TR?
- Congenital e.g. Ebstein’s abnormality
- Rheumatic vasculitis
- Endocarditis
- Scarring from carcinoid heart disease
- Rheumatoid arthritis
- Pulmonary hypertension
What are RF for TR?
- Left sided heart failure
- Rheumatic heart disease
- Permanent pacemaker
- Endocarditis
- Carcinoid heart disease
What are symptoms of TR?
- Fatigue and effort intolerance
- Dyspnoea
- Palpitations
- Peripheral oedema
What are the signs of TR?
- V waves and Y waves in jugular venous pulse
- Irregular hear rhythm: AF or atrial flutter
- Parasternal systolic murmur
- Increased systolic murmur on inspiration (Carvallo’s sign)
- RV heave
- Pulsatile hepatomegaly
What Ix is done for TR?
- Transthoracic or transoesophageal echo
- ECG
- CXR
What bloods are done for TR?
- LFTs
- Serum Urea and Creatinine
- FBC
What is the management of TR?
- treat underlying cause
- valve repair
- Diuretics for systemic congestion
What are complications of TR?
- Atrial arrhythmia
- Advanced liver disease
- AV block
- MI
- Prosthetic valve thrombosis
- Prosthetic valve endocarditis
What are the causes of tricuspid stenosis?
- Rheumatic fever
- Congenital
- Infective endocarditis
What are symptoms of TS?
- Fatigue
- Ascites
- oedema
What are signs of TS?
- Giant a wave and slow y descent in JVP
- Opening snap
- Early diastolic murmur heard at left sternal edge in inspiration
- AF can also occur
What are causes of pulmonary stenosis?
- Congenital (turners, noonan syndrome, Williams syndrome, fallots tetralogy, rubella)
- Carcinoid syndrome
- Rheumatic fever
What are symptoms of pulmonary stenosis?
- Dyspnoea
- Fatigue
- Oedema
- Ascites
What are signs in PS?
- Prominent a wave in JVP
2. RV heave
What are signs in mild PS?
- ejection click
- ejection systolic murmur that radiates to left shoulder
- widely split stenosis
What are signs in severe PS?
murmur becomes longer and obscures A2 and P2 becomes softer and may be inaudible
What Ix is done for PS?
- ECG
- CXR
- Cardiac catherterisation is diagnostic
What does ECG show on PS?
- RAD
- P-pulmonale
- RVH
- RBBB
- echo
What does CXR show in PS?
prominent pulmonary arteries caused by post stenotic dilation
What is the management of PS?
Pulmonary valvuloplasty or valvotomy
What is the cause of pulmonary regurgitation?
any cause of pulmonary hypertension
What are signs of pulmonary regurgitation?
- Decrescendo murmur in early diastole at left sternal edge
- Graham steel murmur is associated with mitral stenosis and pulmonary hypertension
