TRICUSPID STENOSIS AND REGURGITATION

This article has been published by the International Biopharmaceutical Association http://www.ibpassociation.org/ . Please note this article does not give any medical advice.

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TRICUSPID REGURGITATION

Tricuspid regurgitation results in back-flow of blood from the rightventricle into the right atrium.Etiology: Usually occurs functionally as a secondary response to rightventricular enlargement, pulmonary hypertension, or left sided failure.May also occur due to endocarditis (especially for i.v. drug users),Rheumatic heart disease, or right-sided infarct damage to a papillarymuscle.Pathophysiology: Systemic congestion as blood flows backward to the rightatrium and the venous system.Manifestations: Include all symptoms of right-sided failure: systemicedema, hepatomegaly ascites, abdominal right upper quadrant pain, andjaundice.Physical exam will reveal a holosystolic murmur on the right sternalborder and increasing with inspiration. Venous pulse will demonstratelarge v-waves and rapid y-descents. Palpating will reveal a rightventricular thrill and an enlarged pulsating liver.Diagnosis: ECG and chest X-ray will show signs of right heart enlargement.Echocardiography will show this as well, may show the faulty valve andDoppler will follow improper blood flow direction.Managment: Treatment of the underlying cause is always best. Treating theleft-sided failure may restore the right-sided normal function, includingthat of the valve.Surgical repair by anuuloplasty or valve replacement may be advised,especially in cases of rheumatic disease, endocarditis, and ischemia.Diuretics are strongly indicated to treat complications.Prevention: As the case is usually due to a secondary cause, treatment ofthe underlying condition promptly and adequately is the best prevention.

TRICUSPID STENOSIS

Impeded blood flow through the tricuspid valve results in overload of theright atrium, and systemic back up of blood.Etiology: More common in females, usually due to Rheumatic fever andcoincidental to mitrial valve involvement.Pathophysiology: The injured valve impedes blood flow and will result inback-up of blood flow into the systemic circulation causing generalizededema, hepatomegaly, ascites, etc.Manifestations: Heart sounds will reveal along the left sternal border, adiastolic rumbling murmur, increased upon inspiration. Also seen aresigns of edema, hepatomegaly, ascites, jugular distension with a slow ydescent and jaundice.Diagnosis: ECG will reveal an enlarged right atrium, Chest-X-ray will dothe same and show distension of the superior vena cava. Confirmation maybe made with echocardiogram and Doppler or cardiac catheterization.Management: Surgery, usually valve replacement, is necessary in severecases, otherwise drug therapy such as diuretics are indicated for systemiccomplications.

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