Tricuspid Valve Disease

Question 1

3 main causes of TS

Answer 1

Rheumatic heart disease
Carcinoid disease
Congenital malformation

Question 2

TS caused by rheumatic heart disease affects what part of the valve?

Answer 2

Leaflet tips

Question 3

TS caused by carcinoid heart disease affects what part of the valve?

Answer 3

Entire leaflet

Question 4

S&S of TS

Answer 4

SOB
Dizzy
Palpitations
Angina
Cyanosis
JVD

Question 5

Describe the TS murmur

Answer 5

Diastolic murmur
(+/- opening ‘snap’ in diastole from restricted valve movement)

Question 6

What changes might be seen to the TV leaflets with TS?

Answer 6

Thickening
Restricted mobility
Diastolic doming

Question 7

Waveform changes seen with TS

Answer 7

Increased E wave velocity
Increased PHT
Increased DT
Decreased E-F slope

Question 8

What changes would be seen to the RA with moderate to severe TS?

Answer 8

Increased RA size from RVPO

Question 9

What changes would be seen to the RV with significant TS?

Answer 9

Decreased RV size d/t decreased inflow

Question 10

Primary/Mechanical TR exhibits abnormal or normal TV leaflets?

Answer 10

Abnormal

Question 11

Secondary/functional TR exhibits abnormal or normal TV leaflets?

Answer 11

Normal leaflets with dilated annuli

Question 12

Acquired TR is most commonly from what kind of infective process?

Answer 12

Bacterial endocarditis

Question 13

Most common cause of primary TR is caused by?

Answer 13

Myxomatous degeneration

Question 14

Describe the TR murmur

Answer 14

High pitched, holosystolic murmur heard at LUSB

Question 15

S&S of TR

Answer 15

JVD
Anasarca (with severe TR)
CHF
Pedal edema
Hepatomegaly

Question 16

Chronic, severe TR causes what changes to the RA and RV?

Answer 16

Increased RA size and RAP
RVVO
Hypercontractile RV (increased E wave)

Question 17

Mild TR envelope has what kind of appearance? What about more significant TR?

Answer 17

Mild = good envelope
Significant = triangular

Question 18

What plane is TR PISA measured from?

Answer 18

AP4

Question 19

What plane is TR vena contracta measured from?

Answer 19

Parasternal RVIT

Question 20

What happens to hepatic vein flow with severe TR?

Answer 20

Systolic flow reversal

Question 21

Does TR increase or decrease with inspiration?

Answer 21

Increase

Question 22

Can PASP be calculated from TR PG in a patient with PS?

Answer 22

No
RVSP/PASP = 4(TR)^2 - 4(PS)^2

Question 23

How is RAP determined?

Answer 23

IVC diameter / collapse

Question 24

How is the TR PG calculated?

Answer 24

Bernoulli’s equation
RVSP = TR PG + RAP

Question 25

How is TR treated?

Answer 25

Annuloplasty Bicuspidization Edge to edge suture Valve replacement

Question 26

Is TVP the most common valve prolapse?

Answer 26

No, MVP is

Question 27

Is TVP never seen at the same time as MVP?

Answer 27

No, it is almost always seen when there is MVP

Question 28

What is MVP associated with?

Answer 28

Marfan's Ostium secundum defect Ebstein's anomaly

Question 29

What TV leaflets are usually affected in TVP?

Answer 29

Anterior and/or septal leaflet

Question 30

What does TVP cause? How?

Answer 30

TR due to poor coaptation The leaflet gets displaced into the RA in systole

Question 31

What causes flail tricuspid leaflet?

Answer 31

Ruptured pap or multiple torn chordae

Question 32

What happens to the TV leaflet when there is flail?

Answer 32

It becomes dyskinetic and may prolapse into the RA

Question 33

What does TV flail lead to?

Answer 33

Severe TR causing SOB and decreased SPO2

Question 33

What is a common cause of TV flail?

Answer 33

Blunt chest trauma