Tricuspid stenosis/ insufficiency & Pulmonary stenosis/ insufficiency 1B

Question 1

what are the 3 leaflets/cusps of the tricuspid valve called

Answer 1

anterior, posterior and septal or medial

Question 2

Anatomically where does the tricsupid valve lie and what is its function

Answer 2

it lies between the RA and RV

Question 3

During what stage of the cardiac cycle does tricuspid regurgitation occur?

Answer 3

during systole (contraction)

Question 4

What happens during tricuspid regurgitation?

Answer 4

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

Question 5

What type of murmur is heard during tricuspid regurgitation?

Answer 5

holosytolic murmur, due to the movement of blood back the the right atrium

Question 6

What is the sign that can be elicited during physical examinations of a patient with suspected tricuspid regurgitation?

Answer 6

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

Question 7

Morphologically what happens to the heart due to tricuspid regurgitation?

Answer 7

Essentric right ventricle hypertrophy and ultimately right sided heart failure

Question 8

What is the main cause of tricuspid regurgitation?

Answer 8

rheumatic heart disease

Question 9

What is an example of congenital cause of tricuspid regurgitation?

Answer 9

Epstein anomaly where the valve leaflets are too low and in the ventricles instead of invetween the RA& RV

Question 10

Risk factors of tricuspid regurgitation?

Answer 10

marfans syndrome, rheumatic arthritis, endocarditis, left sided heart failure, toxins, constrictive cardiomyopathy

Question 11

Investigations in tricuspid regurgitation?

Answer 11

**Transoesophageal echocardiogram, ECG, LFTs, serum urea and creatinine, FBC, CXR

Question 12

Key diagnostic factors in tricuspid regurgitation?

Answer 12

presence of RF, fatigue, Dyspnoea, jugular venous anaomaly, peripheral oedema, liver pulsation

Question 13

Complications of tricuspid regurgitation?

Answer 13

AF/ flutter, advanced liver disease, atriovententricular block, MI

Question 14

Treatment for tricuspid regurgitation?

Answer 14

maintianing fluid balance and in rare cases valve repair

Question 15

At what stage in the cardiac cycle does tricuspid stenosis occur?

Answer 15

during diastole (relaxation)

Question 16

what happens in tricuspid stenosis?

Answer 16

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

Question 17

What other valves does tricuspid stenosis tend to affect also?

Answer 17

mitral and aortic valve

Question 18

What is a major cause of tricuspid stenosis?

Answer 18

rheumatic fever

Question 19

what is commissural fusion of the valve?

Answer 19

This when inflammation following rheumatic fever causes the leaflets to fuse together and causes the normal tricuspid valve opening to narrow

Question 20

Symptoms of tricuspid stenosis?

Answer 20

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

Question 21

What is a sign/ murmur heard in tricuspid regurgitation?

Answer 21

diastolic rumble (due to blood being forced through the narrow tricuspid valve)

Question 22

A major complication of blood being backed up into the the right atrium due to stenosis?

Answer 22

irritation of the pacemaker cells and an increased risk of arrhythmia such as atrial fibrillation or atrial flutter

Question 23

Risk factors for tricuspid stenosis?

Answer 23

Group A streptococcal pharyngitis and metastatic carcinoid tumours (i.e. secreting serotonin as a paraneoplastic substance)

Question 24

Investigations in tricuspid stenosis?

Answer 24

ECG, CXR, 2D transthoracic echocardiogram, doppler transthoracic echocardiogram, LFTs, FBC

Question 25

Treatment for congenital caused tricuspid stenosis?

Answer 25

surgery + preoperative alprostadil, then post-op anti platelet therapy

Question 26

In carcinoid heart disease, what is the mangement for tricuspid stenosis?

Answer 26

fluid + sodium restriction & loop diuretic and somatostatin

Question 27

Definitive management for tricuspid stenosis?

Answer 27

Balloon valvuloplasty

Question 28

What is the cause of pulmonary stenosis?

Answer 28

congenital causes (fallout, Noonan, rubella) and carcinoid syndrome

Question 29

Type of murmur in pulmonary stenosis?

Answer 29

Ejection systolic murmur radiating to the left shoulder

Question 30

Other signs in pulmonary stenosis?

Answer 30

Prominnet a wave in JVP

Question 31

What happens in pulmonary stenosis?

Answer 31

There is obstruction of blood flow from right ventricle to pulmonary artery

Question 32

What is pulmonary regurgitation?

Answer 32

leaky pulmonary valve during diastole

Question 33

Causes of pulmonary regurgitation?

Answer 33

pulmonary HTN and dilated cardiomyopathy

Question 34

Murmur heard in pulmonary regurgitation?

Answer 34

Early diastolic decrescendo murmur