Tricuspid regurgitation differential diagnosis: Difference between revisions

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*Can be best heard over the fourth intercostal area at left sternal border.
*Can be best heard over the fourth intercostal area at left sternal border.
*The intensity can be accentuated following inspiration ([[Carvallo's sign]]) due to increased regurgitant flow in right ventricular volume.
*The intensity can be accentuated following inspiration ([[Carvallo's sign]]) due to increased regurgitant flow in [[right ventricular]] volume.
*Tricuspid regurgitation is most often secondary to [[pulmonary hypertension]].
*Tricuspid regurgitation is most often secondary to [[pulmonary hypertension]].
*Primary tricuspid regurgitation is less common and can be due to bacterial endocarditis following IV drug use, [[Ebstein's anomaly]], [[carcinoid disease]], or prior [[right ventricular infarction]].
*Primary tricuspid regurgitation is less common and can be due to bacterial [[endocarditis]] following IV drug use, [[Ebstein's anomaly]], [[carcinoid disease]], or prior [[right ventricular infarction]].
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*The murmur in mitral regurgitation is high pitched and best heard at the apex with diaphragm of the stethoscope with patient in the lateral decubitus position.  
*The murmur in [[mitral regurgitation]] is high pitched and best heard at the [[apex]] with diaphragm of the stethoscope with patient in the lateral decubitus position.  
*Left ventricular function can be assessed by determining the apical impulse.  
*Left ventricular function can be assessed by determining the apical impulse.  
*A normal or hyperdynamic apical impulse suggests good ejection fraction and primary mitral regurgitation.  
*A normal or hyperdynamic apical impulse suggests good ejection fraction and primary [[mitral regurgitation]].  
*A displaced and sustained apical impulse suggests decreased ejection fraction and chronic and severe mitral regurgitation.
*A displaced and sustained apical impulse suggests decreased ejection fraction and chronic and severe [[mitral regurgitation]].
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*The holosystolic murmur can be best heard over the left third and fourth intercostal spaces and along the sternal border.
*The holosystolic murmur can be best heard over the left third and fourth intercostal spaces and along the sternal border.
*When the shunt becomes reversed ("[[Eisenmenger's syndrome]]"), the murmur may be absent and S<sub>2</sub> can become markedly accentuated and single.
*When the shunt becomes reversed ([[Eisenmenger's syndrome]]), the murmur may be absent and S<sub>2</sub> can become markedly accentuated and single.
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Revision as of 14:26, 12 September 2014

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

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Overview

The blowing holosystolic murmur of tricuspid regurgitation must be distinguished from mitral regurgitation and a ventricular septal defect.

Differentiating Mitral regurgitation from other Diseases

Tricuspid Regurgitation Mitral Regurgitation VSD
  • The murmur in mitral regurgitation is high pitched and best heard at the apex with diaphragm of the stethoscope with patient in the lateral decubitus position.
  • Left ventricular function can be assessed by determining the apical impulse.
  • A normal or hyperdynamic apical impulse suggests good ejection fraction and primary mitral regurgitation.
  • A displaced and sustained apical impulse suggests decreased ejection fraction and chronic and severe mitral regurgitation.
  • The holosystolic murmur can be best heard over the left third and fourth intercostal spaces and along the sternal border.
  • When the shunt becomes reversed (Eisenmenger's syndrome), the murmur may be absent and S2 can become markedly accentuated and single.

References

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