Tricuspid Stenosis

Question 1

Tricuspid Stenosis:

Etiology

Answer 1

1. rheumatic (most common)
2. congenital (rare)
3. carcinoid( rare)
4. prosthetic valve dysfunction

Question 2

Tricuspid Stenosis:

Most common etiology

Answer 2

rheumatic

Question 3

Tricuspid Stenosis:

rare etiology

Answer 3

1. congenital

2. carcinoid

Question 4

carcinoid vs. rheumatic?

Answer 4

carcinoid= fixed body of the leaflets
rheumatic= tethered leaflet tips

Question 5

Tricuspid Stenosis:

Pathophysiology

Answer 5

1. Increased RA pressure
2. Rheumatic TS almost akways associated with MS
3. Carcinoid heart disease
4. Increased risk for endocarditis

Question 6

Tricuspid Stenosis:

Pathophysiology–> Increased RA pressure causes

Answer 6

RA dilation

Question 7

Tricuspid Stenosis:

Pathophysiology–> Rheumatic TS almost always associated with?

Answer 7

MS

Question 8

Tricuspid Stenosis:

Pathophysiology–> Carcinoid heart disease results from?

Answer 8

Increased serotonin production from a carcinoid tumor (intestinal tract 40% or appendix 25%). sSerotonin induced fibrosis of the right heart endocardium causing TS/TR/PS/PR.

Question 9

Tricuspid Stenosis:

Physical signs–> signs and symptoms may be masked by?

Answer 9

MS

Question 10

Tricuspid Stenosis:

Physical signs–> Murmur

Answer 10

Diastolic murmur (varies with respiration) and an opening snap.

Question 11

Tricuspid Stenosis:

Physical signs–> Symptoms of?

Answer 11

right heart failure

Question 12

Tricuspid Stenosis:

Physical signs–> Symptoms of right heart failure?

Answer 12

1. ascities

2. peripheral edema

Question 13

Tricuspid Stenosis:

M-mode shows?

Answer 13

1. decreased E-F slope
2. multipule echoes
3. reduced amplitude of the “E” wave

Question 14

Tricuspid Stenosis:

Echo–> in carcinoid disease the TV leaflets are?

Answer 14

Thickened and may appear fixed

Question 15

Tricuspid Stenosis:

Echo–>

Answer 15

1. thickened tricuspid leaf;ets with decreased mobility
2. RA and IVC enlargement
3. Tethered TV leaflet tips (doming)

Question 16

Tricuspid Stenosis:

Doppler–>

Answer 16

1. Increased velocity and turbulence across the TV
2. TR may be present
3. Measure mean transvalvular gradient

Question 17

Tricuspid Stenosis:
AHA/ACC guidelines for TS severity
mean gradient (mmHg) significant when?

Answer 17

greater than or equal to 5

Question 18

Tricuspid Stenosis:
AHA/ACC guidelines for TS severity
inflow time velocity integral significant when?

Answer 18

> 60cm

Question 19

Tricuspid Stenosis:
AHA/ACC guidelines for TS severity
TVA by continuity equation (cm sq) significant when?

Answer 19

less than or equal to 1