See also Overview of Cardiac Valvular Disorders Overview of Cardiac Valvular Disorders Any heart valve can become stenotic or insufficient also termed regurgitant or incompetent , causing hemodynamic changes long before symptoms. Most often, valvular stenosis or insufficiency Carcinoid syndrome Carcinoid Syndrome Carcinoid syndrome develops in some people with carcinoid tumors and is characterized by cutaneous flushing, abdominal cramps, and diarrhea.
Right-sided valvular heart disease may develop after Congenital defects eg, cleft tricuspid valve, endocardial cushion defects Atrioventricular Septal Defect Atrioventricular AV septal defect consists of an ostium primum type atrial septal defect and a common AV valve, with or without an associated inlet AV septal type ventricular septal defect Drugs eg, ergotamine , fenfluramine, phentermine.
Ebstein anomaly Ebstein anomaly Other structural congenital cardiac anomalies include the following: Aortopulmonary window Congenitally corrected transposition Double outlet right ventricle Ebstein anomaly read more downward displacement of a congenitally malformed tricuspid cusp into the right ventricle [RV]. Marfan syndrome Marfan Syndrome Marfan syndrome consists of connective tissue anomalies resulting in ocular, skeletal, and cardiovascular abnormalities eg, dilation of ascending aorta, which can lead to aortic dissection Rheumatic fever Rheumatic Fever Rheumatic fever is a nonsuppurative, acute inflammatory complication of group A streptococcal pharyngeal infection, causing combinations of arthritis, carditis, subcutaneous nodules, erythema Valvular abnormalities caused by infective endocarditis Infective Endocarditis Infective endocarditis is infection of the endocardium, usually with bacteria commonly, streptococci or staphylococci or fungi.
It may cause fever, heart murmurs, petechiae, anemia, embolic Iatrogenic causes include pacemaker leads that cross the tricuspid valve and valve damage sustained during RV endomyocardial biopsy.
Secondary tricuspid regurgitation is due to leaflet tethering, which is the result of reduced leaflet coaptation caused by annular dilation typical of right atrial dilation caused by chronic atrial fibrillation Atrial Fibrillation Atrial fibrillation is a rapid, irregularly irregular atrial rhythm.
Symptoms include palpitations and sometimes weakness, effort intolerance, dyspnea, and presyncope. Atrial thrombi may form It has many secondary causes; some cases are idiopathic.
In pulmonary hypertension, pulmonary vessels become constricted Left ventricular failure causes shortness of breath and fatigue, and right ventricular failure causes peripheral and abdominal fluid Tricuspid regurgitation usually causes no symptoms, but some patients experience neck pulsations due to elevated jugular pressures.
Symptoms of severe TR include peripheral edema, fatigue, abdominal bloating, ascites, and anorexia. Patients may also develop symptoms of AF or atrial flutter Atrial Flutter Atrial flutter is a rapid regular atrial rhythm due to an atrial macroreentrant circuit. Signs of moderate to severe tricuspid regurgitation include jugular venous distention, with a prominent merged c-v wave and a steep y descent, and sometimes enlarged liver and peripheral edema.
In severe TR, a right jugular venous thrill may be palpable, as may systolic hepatic pulsation and an RV impulse at the left lower sternal border. Holosystolic murmur heard best at the left middle or lower sternal border frequently not heard. On auscultation, the 1st heart sound S1 may be normal or barely audible if a tricuspid regurgitation murmur is present; the 2nd heart sound S2 may be split with a loud pulmonic component [P2] in pulmonary hypertension or single because of prompt pulmonic valve closing with merger of P2and the aortic component A2.
The murmur of tricuspid regurgitation is frequently not heard. When evident, it is a holosystolic murmur heard best at the left middle or lower sternal border or at the epigastrium with the bell of the stethoscope when the patient is sitting upright or standing. The murmur may be high-pitched if TR is trivial and due to pulmonary hypertension, or it may be medium-pitched if TR is severe and has other causes. When the murmur is not present at all, the diagnosis is best made by the appearance of the jugular venous wave pattern and the presence of hepatic systolic pulsations.
The murmur varies with respiration, becoming louder with inspiration Carvallo sign. Mild tricuspid regurgitation is most often detected on echocardiography Echocardiography This photo shows a patient having echocardiography. This image shows all 4 cardiac chambers and the tricupsid and mitral valves. Cause: Usually due to incompetence of aortic or pulmonary valve.
Examples: Aortic insufficiency; pulmonic regurgitation Sound: Described as like a whispered letter "r". Mitral stenosis Low-pitched, rumbling murmur heard throughout diastole: a whispered letter "r". Pulmonary regurgitation Increases with inspiration Aortic insufficiency Sometimes best heard if the patient is made to site up, lean forward and breathe out fully while the stethoscope at the left side of the lower part of the sternum.
This site uses Akismet to reduce spam. Learn how your comment data is processed. Description Rivero-Carvallo sign : Accentuation of the murmur of tricuspid regurgitation and tricuspid stenosis with inspiration. Rivero-Carvallo applied his newly described maneuver to 4 groups of patients: clinically evident tricuspid insufficiency clinically evident mitral lesions no tricuspid pathology tricuspid rheumatic heart disease and arrhythmias patients with heart failure or arrhythmia without rheumatic heart disease Results showed as increase in the intensity of tricuspid murmurs with maximum intensity over the tricuspid region and with radiation toward the mesocardium or the hepatic zone.
Rivero-Carvallo postulated that: tricuspid systolic murmurs are increased during a maneuver of inspiratory apnoea, and that systolic mitral murmurs diminish its intensity during such a maneuver, which differentiates them clearly the second was that post-expiratory apnoea increases aortic and mitral murmurs and decreases the intensity of tricuspid murmurs. Arch Inst Cardiol Mex. Rivero-Carvallo JM. Un nuovo segno diagnostico della insufficienza tricuspidale [A new diagnostic sign of tricuspid insufficiency].
Cuore e circolazione. Tricuspid incompetence. Br Heart J. Sepulveda G, Lukas DS. The diagnosis of tricuspid insufficiency; clinical features in 60 cases with associated mitral valve disease. Killip T 3rd, Lukas DS. Tricuspid stenosis; physiologic criteria for diagnosis and hemodynamic abnormalities.
Conventional and intracavitary phonocardiographic study ]. Cuore Circ. Intracardiac phonocardiography in tricuspid regurgitation: relation to clinical and angiographic findings. Am J Cardiol. Matsuo H, Morita H et al.
Detection and visualization of regurgitant flow in valvular diseases by pulsed Doppler technique. Jpn Circ J. Bedside diagnosis of systolic murmurs.
0コメント