Right heart valve disease

Question 1

Is tricuspid stenosis more common in men or women?

Answer 1

Women

Question 2

What heart disease commonly underlies tricuspid stenosis?

Answer 2

rheumatic heart disease

Question 3

Describe the pathophysiology of tricuspid stenosis:

Answer 3

tricuspid valve stenosis results in a reduced cardiac output which is restored towards normal when the right atrial pressure increases, causing venous congestion, leading to hepatomegaly, ascites and dependent oedema

Question 4

Give three specific symptoms of tricuspid stenosis:

Answer 4

1) abdominal pain (hepatomegaly)
2) abdominal distension (ascites)
3) peripheral oedema

Question 5

Name 2 auscultation findings associated with tricuspid valve stenosis:

Answer 5

1) rumbling mid-diastolic murmur (heard best at the lower left sternal edge and is louder on inspiration)
2) tricuspid opening snap

Question 6

What is tricuspid stenosis?

Answer 6

is narrowing of the tricuspid orifice that obstructs blood flow from the right atrium to the right ventricle. Almost all cases result from rheumatic fever

Question 7

True or false: sinus rhythm is preserved in tricuspid valve stenosis

Answer 7

True

Question 8

What CXR sign would support a diagnosis of tricuspid valve stenosis?

Answer 8

right atrium buldge

Question 9

What ECG sign would support a diagnosis of tricuspid valve stenosis?

Answer 9

enlarged right atrium is shown by peaked, tall P-waves in lead II

Question 10

What enzymes would be elevated in tricuspid stenosis?

Answer 10

Liver enzymes are elevated because of passive hepatic congestion

Question 11

Give 3 treatments used for tricuspid stenosis:

Answer 11

1) diuretic therapy
2) salt restriction
3) valve replacement (rarely considered)

Question 12

What is tricuspid regurgitation?

Answer 12

Tricuspid regurgitation (TR) is insufficiency of the tricuspid valve causing blood flow from the right ventricle to the right atrium during systole.

Question 13

What are the two types of tricuspid regurgitation?

Answer 13

1. Functional - occurs when the RV dilates e.g. due to corpulmonale, MI or pulmonary hypertension
2. Organic - occurs with rheumatic heart disease, infective endocarditis, carcinoid syndrome or congenital abnormalities

Question 14

Describe the pathophysiology of tricuspid regurgitation:

Answer 14

the regurgitation gives rise to high right atrial and systemic venous pressures causing venous backlog -> oedema, hepatomegaly, ascites

Question 15

Give 3 clinical signs of tricuspid regurgitation:

Answer 15

1) palpable liver (hepatomegaly) that pulsates in systole
2) blowing pan-systolic murmur, best heard on inspiration at the left sternal edge
3) AF

Question 16

What auscultation finding is associated with tricuspid regurgitation?

Answer 16

blowing pan-systolic murmur, best heard on inspiration at the left sternal edge

Question 17

Name 2 echocardiogram findings that would support a diagnosis of tricuspid regurgitation:

Answer 17

1) dilated right ventricle
2) thickened tricuspid valve

Question 18

Describe the management for severe organic tricuspid regurgitation:

Answer 18

operative repair

Question 19

Describe the management for functional tricuspid regurgitation:

Answer 19

it usually disappears with medical management

Question 20

What is pulmonic stenosis?

Answer 20

Pulmonic stenosis (PS) is narrowing of the pulmonary outflow tract causing obstruction of blood flow from the right ventricle to the pulmonary artery during systole.

Question 21

What is the most common cause of pulmonary stenosis?

Answer 21

congenital abnormality

Question 22

Other than congenital abnormalities, name another cause of pulmonary stenosis:

Answer 22

rheumatic/ carcinoid syndrome

Question 23

What are 3 congenital disorders that present with pulmonary stenosis?

Answer 23

1. tetralogy of Fallot
2. Noonan’s syndrome
3. Congenital rubella syndrome

Question 24

Describe the pathophysiology of pulmonary stenosis:

Answer 24

the obstruction of right ventricular emptying results in right ventricular hypertrophy which in turn leads to right atrial hypertrophy - the heart struggles to overcome the resistance created by stenosis, causing fatigue and syncope, eventually leading to right sided heart failure

Question 25

Give 3 symptoms associated with pulmonary stenosis:

Answer 25

1) fatigue 2) syncope 3) symptoms of RV heart failure (ascites, hepatomegaly)

Question 26

Give 2 auscultation sounds that would be heart in pulmonary stenosis:

Answer 26

1. Harsh, mid-systolic ejection murmur (best heard on inspiration to the left of the sternum in the second intercostal space) 2. Right ventricular heave

Question 27

What CXR finding would align with a pulmonary stenosis diagnosis?

Answer 27

prominent pulmonary artery due to post-stenotic dilation

Question 28

How is severe pulmonary stenosis treated?

Answer 28

pulmonary valvotomy (balloon valvotomy or direct surgery)

Question 29

What is pulmonary regurgitation?

Answer 29

is incompetency of the pulmonic valve causing blood flow from the pulmonary artery into the right ventricle during diastole

Question 30

What causes pulmonary regurgitation?

Answer 30

dilation of the pulmonary valve ring which occurs in pulmonary hypertension

Question 31

What auscultation finding is associated with pulmonary regurgitation?

Answer 31

decrescendo-diastolic murmur beginning with the pulmonary component of the second heart sound (difficult to differentiate from aortic regurgitation murmur)

Question 32

True or false: pulmonary regurgitation often causes no symptoms and treatment is rarely necessary

Answer 32

true