Tricuspid stenosis physical examination

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Normally, tricuspid stenosis co-exists with mitral stenosis, thus depending on the severity of mitral valve pathology, symptoms differ. Since these two diseases often coexist, the diagnosis of tricuspid stenosis may be missed. Patients can lay flat without any symptoms in absence of serious mitral valve pathology and thus not present with any signs of dyspnea. Characteristic findings of tricuspid stenosis include opening snap and a diastolic rumbling murmur that is localized to the the right sternal border and that increases with inspiration.

Physical Examination

Neck

• An elevated jugular venous pulse may be present.
• "a wave" is prominent but in presence of atrial fibrillation, "a wave" is lost.
• "y" descent is slow.

Heart

Palpation

• Patients with tricuspid stenosis may feature a prominent right atrium palpable to the right of the sternum.

Auscultation

Heart Sounds

• A tricuspid opening snap may be heard if it is not obscured by the sounds of mitral stenosis.
• First heart sound, S1 may be widely fixed.
• Second heart sound, S2 may be single.

Murmurs

• Mid diastolic murmur is present.
• The murmur is best heard over the left sternal border with rumbling character and tricuspid opening snap with wide splitting of S1.
• The murmur of tricuspid stenosis may increase in intensity with inspiration (Carvallo's sign), leg raising and squatting.
• Tricuspid regurgitation oftentimes presents in a similar location, delineated by a holosystolic murmur.

Abdominal

• Patients frequently experience peripheral edema, hepatomegaly and ascites.