Tricuspid stenosis/ insufficiency & Pulmonary stenosis/ insufficiency 1B Flashcards
what are the 3 leaflets/cusps of the tricuspid valve called
anterior, posterior and septal or medial
Anatomically where does the tricsupid valve lie and what is its function
it lies between the RA and RV
During what stage of the cardiac cycle does tricuspid regurgitation occur?
during systole (contraction)
What happens during tricuspid regurgitation?
normally the tricuspid valve is closed however due to pathology the valve does not close properly and blood leaks back from the right ventricle back to the right atrium
What type of murmur is heard during tricuspid regurgitation?
holosytolic murmur, due to the movement of blood back the the right atrium
What is the sign that can be elicited during physical examinations of a patient with suspected tricuspid regurgitation?
Carvallo sign- this is when the murmur gets louder during inspiation due to the negative pressure on the heart hence more blood flow from the right ventricle back to the right atrium causing the murmur to be louder
Morphologically what happens to the heart due to tricuspid regurgitation?
Essentric right ventricle hypertrophy and ultimately right sided heart failure
What is the main cause of tricuspid regurgitation?
rheumatic heart disease
What is an example of congenital cause of tricuspid regurgitation?
Epstein anomaly where the valve leaflets are too low and in the ventricles instead of invetween the RA& RV
Risk factors of tricuspid regurgitation?
marfans syndrome, rheumatic arthritis, endocarditis, left sided heart failure, toxins, constrictive cardiomyopathy
Investigations in tricuspid regurgitation?
**Transoesophageal echocardiogram, ECG, LFTs, serum urea and creatinine, FBC, CXR
Key diagnostic factors in tricuspid regurgitation?
presence of RF, fatigue, Dyspnoea, jugular venous anaomaly, peripheral oedema, liver pulsation
Complications of tricuspid regurgitation?
AF/ flutter, advanced liver disease, atriovententricular block, MI
Treatment for tricuspid regurgitation?
maintianing fluid balance and in rare cases valve repair
At what stage in the cardiac cycle does tricuspid stenosis occur?
during diastole (relaxation)
what happens in tricuspid stenosis?
normally the valve is open for the RV to fill properly however in stenosis, the valve does not completely open, resulting in difficulty filling the RV
What other valves does tricuspid stenosis tend to affect also?
mitral and aortic valve
What is a major cause of tricuspid stenosis?
rheumatic fever
what is commissural fusion of the valve?
This when inflammation following rheumatic fever causes the leaflets to fuse together and causes the normal tricuspid valve opening to narrow
Symptoms of tricuspid stenosis?
Symptoms of right sided heart failure; distended neck veins, peripheral oedema, hepatosplenomegaly; this is due to increased blood build up in the right atrium and right sided heart failure
What is a sign/ murmur heard in tricuspid regurgitation?
diastolic rumble (due to blood being forced through the narrow tricuspid valve)
A major complication of blood being backed up into the the right atrium due to stenosis?
irritation of the pacemaker cells and an increased risk of arrhythmia such as atrial fibrillation or atrial flutter
Risk factors for tricuspid stenosis?
Group A streptococcal pharyngitis and metastatic carcinoid tumours (i.e. secreting serotonin as a paraneoplastic substance)
Investigations in tricuspid stenosis?
ECG, CXR, 2D transthoracic echocardiogram, doppler transthoracic echocardiogram, LFTs, FBC
