Right Heart Valve Disease Flashcards
What are the different types of right heart valve diseases?
- Tricuspid stenosis
- Tricuspid regurgitation
- Pulmonary stenosis
- Pulmonary regurgitation
What is tricuspid stenosis?
A very rare valvular abnormality where there is narrowing of the tricuspid orifice that obstructs blood flow from the right atrium to the right ventricle. This results in systemic congestion and failure to augment right ventricle output.
what is tricuspid regurgitation
Tricuspid regurgitation (TR) is the reversal of blood flow across the tricuspid valve back into the right atrium (from the RV) due to valve incompetence.
- Pulsatile liver is seen in cases of severe tricuspid regurgitation due to backflow of blood into the liver during systole.
What is pulmonary stenosis?
Pulmonary stenosis is a condition characterised by the narrowing of the pulmonary valve, leading to reduced blood flow from the right ventricle to the lungs.
- It is most commonly a congenital condition associated with syndromes such as Tetralogy of Fallot, Noonan syndrome, and Williams syndrome.
- Noonan syndrome is most commonly associated with pulmonary stenosis.
- It causes an ejection systolic murmur loudest at the pulmonary area and radiating to the shoulder rather than the carotids)
What is pulmonary regurgitation?
Pulmonary valve regurgitation occurs when the pulmonary valve doesn’t completely close and allows some blood to leak back into the heart. This condition is also known as pulmonic regurgitation, pulmonic insufficiency and pulmonary insufficiency.
What are the causes of right heart valve diseases?
- Tricuspid Regurgitation Causes → RV dilatation (eg. due to pulmonary hypertension), rheumatic fever, IE (in IV drug abusers), congenital
- Tricuspid Stenosis Causes → rheumatic fever, which almost always occurs with mitral or aortic valve disease
- Pulmonary Stenosis Causes → usually congenital (ToF)
- Pulmonary Regurgitation Causes → any cause of pulmonary hypertension
What are the presenting symptoms of right heart valve diseases?
- Tricuspid Regurgitation → fatigue, hepatic pain, ascites, oedema, elevated JVP. Pansystolic murmur, hepatomegaly, jaundice.
- Tricuspid Stenosis → fatigue, ascites, oedema. Early diastolic murmur.
- Pulmonary Stenosis → dyspnoea, fatigue, oedema, ascites. Ejection systolic murmur.
- Pulmonary Regurgitation → decrescendo murmur in early diastole
What signs of RH valve diseases can be found on physical examination?
- Pulse- irregularly irregular if AF
- Inspection
- Raised JVP with giant V waves (which may oscillate the earlobes)
- Giant A waves may also be present - Palpation- parasternal heave
- Auscultation
- Pansystolic murmur - heard best at lower left sternal edge
- Louder on inspiration (Carvallo sign)
- Loud P2 component of second heart sound - Chest Examination may show signs of:
- Pleural effusion
- Causes of pulmonary hypertension - Signs of right sided heart failure:
- Ascites
- Peripheral oedema
- Pulsatile hepatomegaly
- (Pulsatile liver is seen in cases of severe tricuspid regurgitation due to backflow of blood into the liver during systole.)
What investigations are used to diagnose/ monitor RH valve diseases?
- Bloods:
- FBC
- LFT
- Cardiac enzymes
- Blood cultures - ECG:
- P pulmonale - due to right atrial hypertrophy - Echocardiography:
- Extent of regurgitation can be estimated using Doppler ultrasound
- May show valve prolapse and right ventricular dilation - Right Heart Catheterisation:
- Rarely necessary but may be useful for assessing pulmonary artery pressure
How are RH valve diseases managed?
- Tricuspid Regurgitation → diuretics (for systemic congestion) + valve repair or replacement
- Tricuspid Stenosis → diuretics + surgical repair
- Pulmonary Stenosis → pulmonary valvuloplasty or valvotomy
- Currently, medications are not used to help with pulmonary regurgitation itself, but medications may be used to help the heart to pump more efficiently. In severe cases of pulmonary regurgitation, surgery may be needed to repair or replace the pulmonary valve.
