Tricuspid atresia physical examination
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor-In-Chief: Keri Shafer, M.D. [2] Priyamvada Singh, MBBS[3] Assistant Editor-In-Chief: Kristin Feeney, B.S. [4]
Physical Examination
Diagnosis
Diagnostic Criteria
The diagnosis of tricuspid atresia is made when at least of the following three diagnostic criteria are met in echocardiography: Absent of color flow doppler in tricuspid valve region
- ASD or PFO
- Small right ventricle
- Left atrium dilation
- Left ventricle dilation
Symptoms
Symptoms of tricuspid atresia in neonates may include the following:
- Central cyanosis in mucous membranes and tongue
- Poor feeding and growth retardation
- Difficulty in breathing
- Rapid heartbeat
- Rapid breathing
Symptoms of longstanding cyanosis and hyperviscosity syndrome as a result of secondary erythrocytosis in older children include the following:
- Headache
- Alter mentation
- Faintness
- Dizziness
- Visual disturbances
- Paresthesia
- Tinnitus
- Myalgia
Physical Examination
- Patients with pulmonary stenosis and closed PAD usually appear cyanotic after birth.
- Physical examination may be remarkable for:
- Normal pulses
- Diminished right ventricle impulse
- Thrill due to VSD or severe PS
- Holosystolic murmured in LSB due to VSD
- The continuous murmur of PDA, occasionally
- Systolic ejection murmur in left upper sternal border due to PS
- clubbing in older patients and unrepaired disease.
- Patients with high pulmonary blood flow without stenotic pulmonary arteries and with VSD are not cyanotic at birth.
- Physical examination may be remarkable for symptoms and signs of overt heart failure:
- Tachypnea
- poor feeding
- poor growth
Heart
- The apical impulse is hyper-dynamic and shifted to the left.
- A thrill can be felt on the left parasternal region of the chest.
- Intensity of S1 may be increased.
- Split S2 may be present.
- A holosystolic crescendo - decrescendo murmur may be present signifying the flow of blood through a ventricular septal defect.
- Rough, systolic murmur best heard in the third intercostal space close to the sternum.
Abdomen
- Liver is enlarged and pulsations may be felt in the right upper quadrant of the abdomen.
- Splenic enlargement