Tricuspid stenosis physical examination
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Physical Examination
Vital signs
- A pulsus paradoxus may be present
Neck
- An elevated jugular venous pulse may be present
Heart
- A mid diastolic murmur can be heard during auscultation
- This is caused by the blood flow through the stenotic valve
- This is best heard over the left sternal border with rumbling character and tricuspid opening snap with wide splitting S1
- The murmur of tricuspid stenosis may increase in intensity with inspiration (Carvallo's sign)
- Jugular Venous Pulse:
- Sinus rhythm: jugular venous pulse increases and A wave is prominent
- This may be confused with arterial pulse
- Atrial fibrillation: A wave is lost
- Sinus rhythm: jugular venous pulse increases and A wave is prominent
- Patients with tricuspid stenosis may feature a prominent right atrium palpable to the right of the sternum
- A tricuspid opening snap may be heard if it not obscured by the sounds of mitral stenosis
- At either the left sternal border or at the xiphoid process, a diastolic murmur can be heard, increasing with inspiration
- Tricuspid regurgitation oftentimes presents in a similar location, delineated by a holosystolic murmur
Abdominal
- Patients frequently experience peripheral edema and ascites
Severity of Disease Presence
- If patients do not have significant mitral pathology, they will most likely not experience dyspnea
- Patients may be able to lay flat without symptoms