Tricuspid stenosis physical examination
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Physical Examination
Normally tricuspid stenosis co-exists with mitral stenosis, thus depending on the severity of mitral valve pathology, symptoms differ. Patients can lay flat without symptoms in absence of serious mitral valve pathology.
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
- Its a mid diastolic murmur.
- It is caused by the blood flow through the stenotic valve .
- It 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.