tricuspid stenosis

Question 1

causes

Answer 1

This condition occurs as a result of rheumatic heart disease. There is almost always coexistent mitral valve disease.

Other rarer causes of tricuspid stenosis include:

• carcinoid tumours of the small intestine with hepatic secondaries (very rare)
• congenital (very rare)

Question 2

s.s

Answer 2

Possible symptoms include:

• fatigue (due to a low cardiac output)
• ascites
• hepatic pain
• dependent oedema e.g. ankle swelling

Possible signs include:

JVP:

• giant a wave
• small v wave
• slow y descent

auscultation:

• early diastolic murmur (at the left sternal edge, heard best in inspiration)
• opening snap

Question 3

ix

Answer 3

• ECG:
  
  • right atrial hypertrophy (P pulmonale)
• echocardiography and doppler ultrasound:
  
  • thickened tricuspid leaflets
  • stenotic jet
• cardiac catheterization and angiography:
• end-diastolic gradient across tricuspid valve

Question 4

mx

Answer 4

seek expert advice:

Management options include:

• diuretics
• occasionally surgical repair