Right Heart Valvular Disease - Tricuspid Valve

Question 1

When we listen to the heart we should be able to hear 2 separate sounds, S1 and S2. What does S1 relate to?

1 - closing of the tricuspid and mitral valves
2 - closing of tricuspid and aortic valves
3 - closing of mitral and aortic valves
4 - closing of aortic and pulmonary valves

Answer 1

1 - closing of the tricuspid and mitral valves
- also called the atrioventricular valves, as these 2 valves relate to the atrium

Question 2

Does the S1 heart sound occur at the start of diastole or systole?

Answer 2

• systole
• mitral and tricuspid valves close to stop blood moving back into the atrium

Question 3

When we listen to the heart we should be able to hear 2 separate sounds, S1 and S2. What does S2 relate to?

1 - closing of the tricuspid and mitral valves
2 - closing of tricuspid and aortic valves
3 - closing of mitral and aortic valves
4 - closing of aortic and pulmonary valves

Answer 3

4 - closing of aortic and pulmonary valves

Question 4

Does the S2 heart sound occur at the start of diastole or systole?

Answer 4

• diastole
• aortic and pulmonary valves close to allow atria to pump blood into ventricles

Question 5

In some patients a 3rd heart sound can be heard, S3, which occurs just after S2. What causes this 3rd heart sound?

1 - mitral regurgitation
2 - ventricular septal defect
3 - chordae tendineae pulling
4 - aortic regurgitation

Answer 5

3 - chordae tendineae pulling
- papillary muscles contract and pull chordae tendineae which attach to mitral valves

• sound is because they pull so hard to fully expand the left ventricle
• can be heard in some younger patients, BUT can signify HR in older patients

Question 6

How many leaflets does the tricuspid valve have?

1 - 4
2 - 3
3 - 2
4 - 1

Answer 6

2 - 3

Question 7

Does the tricuspid valve open during systole or diastole?

Answer 7

• diastole
• allows left ventricle to be filled

Question 8

Does the mitral valve close during systole or diastole?

Answer 8

• systole
• allows LV to pump blood around the body

Question 9

Does the tricuspid valve close during systole or diastole?

Answer 9

• systole
• allows right ventricle to pump blood to the lungs via the pulmonary arteries

Question 10

All of the following are causing of tricuspid valve regurgitation, but which is the leading cause?a

1 - Infective Endocarditis
2 - Degenerative
3 - RV dilation
4 - Rheumatic

Answer 10

3 - RV dilation
- pulmonary hypertension, left sided heart failure or PE

Question 11

When a patient has tricuspid regurgitation a murmur can be heard. At what time point around other heart sounds can this murmur be heard?

1 - after S2
2 - after S1
3 - after S3
4 - throughout S1 to S2

Answer 11

4 - throughout S1 to S2
called a holosystolic murmur
- blood continually flows back into RA throughout systole

Question 12

In tricuspid regurgitation what happens to the RV?

1 - concentric hypertrophy
2 - becomes fibrotic and stiff
3 - increased pressure causes VSD
4 - eccentric hypertrophy

Answer 12

4 - eccentric hypertrophy
- this stretches the annulus of the tricuspid valve and increases tricuspid regurgitation

Question 13

Patients with tricuspid regurgitation typically present with all of the following symptoms, EXCEPT which one?

1 - fatigue
2 - dehydration
3 - hepatic pain
4 - ascites

Answer 13

2 - dehydration
- typically leads to oedema

• hepatic pain = on exertion due to congestion with fluid in the liver

Question 14

Patients with tricuspid regurgitation typically present with all of the following clinical signs, EXCEPT which one?

1 - raised JVP
2 - RV heave
3 - hepatosplenomegaly
4 - glossitis

Answer 14

4 - glossitis

Question 15

All of the following are causing of tricuspid valve stenosis, but which is the leading cause

1 - Infective Endocarditis
2 - Degenerative
3 - RV dilation
4 - Rheumatic fever

Answer 15

4 - Rheumatic fever
- commonly occurs with aortic and mitral stenosis

Question 16

When a patient has tricuspid stenosis a murmur can be heard. At what time point around other heart sounds can this murmur be heard?

1 - after S2
2 - after S1
3 - after S3
4 - throughout S1 to S2

Answer 16

1 - after S2
- characterised by a snapping sound before S1
- caused by tricuspid valve remaining shit until enough pressure forces it open

Question 17

If the tricuspid valve cannot open, the RA dilates and can increase the risk of what?

1 - abnormal electrical conductance
2 - AF
3 - atrial flutter
4 - all of the above

Answer 17

4 - all of the above

Question 18

Patients with tricuspid stenosis typically present with all of the following clinical signs, EXCEPT which one?

1 - raised JVP
2 - RV heave
3 - hepatosplenomegaly
4 - glossitis

Answer 18

4 - glossitis

Question 19

Patients with tricuspid stenosis can have dysphagia and hoarseness. Why is this?

1 - increased CO2 retention
2 - enlarged RA
3 - hypoxia
4 - lack of blood flow

Answer 19

2 - enlarged RA
- presses on oesophagus and recurrent laryngeal nerve

Question 20

Patients with tricuspid stenosis typically present with all of the following symptoms, EXCEPT which one?

1 - fatigue
2 - dehydration
3 - hepatic pain
4 - ascites

Answer 20

2 - dehydration

Question 21

All of the following are tests to diagnose a patient with suspected tricuspid regurgitation and stenosis, but which generally provides a definitive diagnosis and is regularly used?

1 - echocardiogram
2 - ECG
3 - CXR
4 - transoesophageal echocardiogram
5 - cardiac catheterisation

Answer 21

1 - echocardiogram

Question 22

Which medication is most commonly used in patients with suspected tricuspid regurgitation and stenosis?

1 - furosemide
2 - ramipril
3 - bisoprolol
4 - rivaroxaban

Answer 22

1 - furosemide
- all the others can be used help, especially with AF, but the fluid overload is the key issue

Question 23

If the patient is presenting with suspected tricuspid regurgitation and stenosis and has symptoms, what treatment can be performed?

1 - tricuspid valve replacement
2 - balloon valvuloplasty
3 - tricuspid valve repair
4 - all of the above

Answer 23

4 - all of the above

Question 24

Complete the table below using the labels below using systole or diastole of when you would hear the murmurs:

Answer 24