Pulmonary & Tricuspid Valve Diseases

• Tricuspid stenosis

  Causes

  • Usually due to rheumatic heart disease, in which mitral and aortic valves are also affected.
  • Rarely due to tricuspid atresia, atrial tumour, or infective endocarditis.

  Signs and symptoms

  • Mid-diastolic murmur, after opening snap. Best heard in left parasternal area.
  • Giant presystolic a waves and slow Y descent in JVP.

• Tricuspid regurgitation

  Causes

  • Functional: RV dilatation, usually due to pulmonary HTN which may be secondary to LVF.
  • Carcinoid syndrome.
  • Tricuspid atresia, a cyanotic congenital heart disease.
  • Infective endocarditis, typically in an IV drug user.

  Signs and symptoms

  • Pan-systolic murmur.
  • Parasternal heave.
  • Prominent V wave in JVP.
  • RVF signs if severe including ascites and liver signs (enlarged, pulsatile, painful, jaundice).

• Pulmonary stenosis

  Causes

  • Congenital: Fallot, Noonan, rubella.
  • Carcinoid syndrome.

  Signs and symptoms

  • Ejection systolic murmur radiating to left shoulder.
  • Ejection click.
  • Prominent a in JVP.
  • Wide split S2: P2 is delayed due to slow emptying through narrow valve.

• Pulmonary regurgitation

  Causes

  • Pulmonary HTN.
  • Dilated cardiomyopathy.

  Signs and symptoms

  • Often mild and asymptomatic.
  • Early diastolic decrescendo murmur.