Right Heart Valve disease Flashcards
Aetiology of tricuspid regurgitation
Primary:
Congenital: Ebstein’s anomaly, AV canal defect, Marfan’s syndrome
Acquired:
- Rheumatic fever
- Infective endocarditis (IVDU)
- Carcinoid heart disease → scarring
- Rheumatoid arthritis
- Valve prolapse
- Trauma (blunt force, biopsies)
Secondary
Left-sided pathology → pulmonary HTN → RV dilatation
Symptoms of tricuspid regurgitation
Fatigue
Headaches
Nausea
Anorexia
Breathlessness
Palpitations
Epigastric pain that worsens on exercise
Jaundice
Lower limb swelling
Signs of tricuspid regurgitation
Pulse: irregularly irregular due to AF (May occur with Right atrial enlargement)
Inspection: Raised JVP
- Giant v waves may oscillate earlobe
- Giant a wave may be present if patient in sinus rhythm
Palpation: Parasternal heave
Auscultation: Pan-systolic murmur
- Heard best at the lower left sternal edge
- Louder on inspiration (Carvallo sign)
- Loud P2 component of S2
Chest: pleural effusion, a cause of pulmonary HTN e.g. emphysema
Abdo: palpable liver (tender, smooth, pulsatile), ascites
Legs: pitting oedema
Investigations for tricuspid regurgitation
ECG: RAH → tall P wave
FBC, U&Es, LFTs, troponin, blood cultures
CXR: right heart enlargement, cardiomegaly, effusion
Echo: diagnostic
Right heart catheterisation: before valve repair to assess pulmonary artery pressure
Management for tricuspid regurgitation
Medical: Treat underlying condition | Diuretics given if fluid retention
Surgery: Annuloplasty, plication or replacement | Repair only if severe | Surgical removal of valve if infective endocarditis