Tricuspid valve pathology Flashcards
acute causes of TR
Infective endocarditis
Major Trauma
Chronic causes of TR
Pulmonary HTN
Endocarditiis
Ebsteins anomaly
Rheumatic heart disease
Carcinoid syndrome
Functional causes of TR
Mitral valve disease
Pulmonary HTN
VSD
ASD
PDA
What is Ebsteins abnormality
this is apical displacement of the tricuspid valve
(TV), but particularly of the septal leafl et. The tricuspid valve is
normally offset from the MV slightly towards the apex, but in Ebstein’s this is grossly exaggerated. The result is a deformed TV which always is at least moderately regurgitant.
Causes of Ebstiens
Association with WPW
Teratogenic effect of lithium during pregnancy
Signs of TR (not auscultation)
CV waves on JVP
Pulsatile hepatomegally
Parasternal heave
Auscultation of TR
Pansystolic murmur heard at left sternal edge louder on inspiration
Reverse splitting of S2
Why is it called a CV wave?
Inspection of the diagram of the JVP shows that the C wave is the point of closure of the TV. If TR is present therefore, it will start at this point and continue throughout RV systole (i.e. the period of the V wave). Hence CV wave.
Why is TV IE more common in IVDU?
Damage to TR due to particulate matter of substances the drug is cut with. Causes damage to TV and predisposes to being seeded with bacteria.
Investigation into TR
ECG - p-pulmonale
XR chest - double heart border (enlarged RA)
TTE
Medical management of TR
Diurectics, beta blockers, ACEIs
management of underlying conditions causing pulmonary HTN
Surgical intervention into TR
Valve repair
Annuloplasty
Causes of Tricuspid stenosis
Carcinoid syndrome
Rheumatic fever
parital tricuspid atresia
What is carcinoid syndrome
Gut primary. Carcinoid syn usually occurs when metastases are present in the liver and release serotonin into the systemic circulation may also occur with lung carcinoid as mediators are not ‘cleared’ by the liver
Symptoms of carcinoid syndrome
flushing (often the earliest symptom)
diarrhoea
bronchospasm
hypotension
right heart valvular stenosis (left heart can be affected in bronchial carcinoid)
other molecules such as ACTH and GHRH may also be secreted resulting in, for example, Cushing’s syndrome
pellagra can rarely develop as dietary tryptophan is diverted to serotonin by the tumour
