TRICUSPID STENOSIS
Etiology
- Rheumatic heart disease
- TS in seen in Carcinoid syndrome
- Commonly associated with mitral + aortic valve disease
Pathophysiology
- TS results in ↓cardiac output and ↑RA pressure
- Results in systemic venous congestion
Clinical features
- In a pt with TS, sx of the associated mitral and aortic valve are more pronounced – LHF (left heart failure)
- Sx of TS are of RHF – hepatomegaly, ascites , peripheral oedema
- Prominent jugular venous a-wave
Diagnosis
- CXR – right atrial bulge
- ECG – tall P waves in lead II (enlarged RA)
- Echo – thickened and immobile tricuspid valve
Treatment
- Diuretics
- Valvotomy/valve replacement
2. TRICUSPID REGURGITATION
Etiology
- Functional TR – occurs whenever the RV dilates e.g. in cor pulmonale, MI, pulm HTN
- Organic TR – occurs in rheumatic heart disease, infective endocarditis, carcinoid syn, Ebstein’s anomaly
Clinical features
- TR results in ↑RA pressure and ↑systemic venous pressure – pts complain for sx of RHF
- Tiredness, oedema, hepatomegaly, ascites
- Large jugular venous cv-wave – replaces the normal x decent
- Palpable, pulsatile liver
- Pansystolic murmur
Diagnosis
- Echo – RV dilation and thick tricuspid valve
Treatment
- Functional TR – usually resolves with medical management
- Organic TR – tricuspid valve annuloplasty