Tricuspid Valve Disease Flashcards
3 main causes of TS
Rheumatic heart disease
Carcinoid disease
Congenital malformation
TS caused by rheumatic heart disease affects what part of the valve?
Leaflet tips
TS caused by carcinoid heart disease affects what part of the valve?
Entire leaflet
S&S of TS
SOB
Dizzy
Palpitations
Angina
Cyanosis
JVD
Describe the TS murmur
Diastolic murmur
(+/- opening ‘snap’ in diastole from restricted valve movement)
What changes might be seen to the TV leaflets with TS?
Thickening
Restricted mobility
Diastolic doming
Waveform changes seen with TS
Increased E wave velocity
Increased PHT
Increased DT
Decreased E-F slope
What changes would be seen to the RA with moderate to severe TS?
Increased RA size from RVPO
What changes would be seen to the RV with significant TS?
Decreased RV size d/t decreased inflow
Primary/Mechanical TR exhibits abnormal or normal TV leaflets?
Abnormal
Secondary/functional TR exhibits abnormal or normal TV leaflets?
Normal leaflets with dilated annuli
Acquired TR is most commonly from what kind of infective process?
Bacterial endocarditis
Most common cause of primary TR is caused by?
Myxomatous degeneration
Describe the TR murmur
High pitched, holosystolic murmur heard at LUSB
S&S of TR
JVD
Anasarca (with severe TR)
CHF
Pedal edema
Hepatomegaly
Chronic, severe TR causes what changes to the RA and RV?
Increased RA size and RAP
RVVO
Hypercontractile RV (increased E wave)
Mild TR envelope has what kind of appearance? What about more significant TR?
Mild = good envelope
Significant = triangular
What plane is TR PISA measured from?
AP4
What plane is TR vena contracta measured from?
Parasternal RVIT
What happens to hepatic vein flow with severe TR?
Systolic flow reversal
Does TR increase or decrease with inspiration?
Increase
Can PASP be calculated from TR PG in a patient with PS?
No
RVSP/PASP = 4(TR)^2 - 4(PS)^2
How is RAP determined?
IVC diameter / collapse
How is the TR PG calculated?
Bernoulli’s equation
RVSP = TR PG + RAP
How is TR treated?
Annuloplasty
Bicuspidization
Edge to edge suture
Valve replacement
Is TVP the most common valve prolapse?
No, MVP is
Is TVP never seen at the same time as MVP?
No, it is almost always seen when there is MVP
What is MVP associated with?
Marfan’s
Ostium secundum defect
Ebstein’s anomaly
What TV leaflets are usually affected in TVP?
Anterior and/or septal leaflet
What does TVP cause? How?
TR due to poor coaptation
The leaflet gets displaced into the RA in systole
What causes flail tricuspid leaflet?
Ruptured pap or multiple torn chordae
What happens to the TV leaflet when there is flail?
It becomes dyskinetic and may prolapse into the RA
What does TV flail lead to?
Severe TR causing SOB and decreased SPO2
What is a common cause of TV flail?
Blunt chest trauma
