Tricuspid regurgitation physical examination: Difference between revisions
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==Overview== | ==Overview== | ||
On examination, the [[jugular venous pressure]] is usually elevated, and 'CV' waves can be seen. The liver may be enlarged and is often pulsatile (the latter finding being virtually diagnostic of tricuspid insufficiency). Peripheral edema is often found. In severe cases, there may be [[ascites]] and even [[cirrhosis]] (so-called 'cardiac cirrhosis). [[Tricuspid insufficiency]] may lead to the presence of a pansystolic [[heart murmur]]. Such a murmur is usually of low frequency and best heard low on the left sternal border. It tends to increase with inspiration. However, the murmur may be inaudible reflecting the relatively low pressures in the right side of the heart. A third heart sound may also be present. | |||
On examination, the [[jugular venous pressure]] is usually elevated, and 'CV' waves can be seen. The liver may be enlarged and is often pulsatile (the latter finding being virtually diagnostic of tricuspid insufficiency). Peripheral edema is often found. In severe cases, there may be [[ascites]] and even [[cirrhosis]] (so-called 'cardiac cirrhosis). | |||
[[ | ==Physical Examination== | ||
Clinical findings found in patients presenting with tricuspid regurgitation are as a result of right sided [[heart failure]] and regurgitant blood flow across the tricuspid valve into the right atria during ventricular contraction. Patients with right sided heart failure may present with peripheral edema, [[cyanosis]], hepatosplenomegaly, ascitis, [[cachexia]] and [[jaundice]]. Signs of left sided heart failure will dominate in case of left ventricular dysfunction. | |||
===Neck=== | |||
* [[JVP]] is prominent and jugular venous distention is present. | |||
* "[[V wave]]" is prominent as a result of systolic regurgitation into right atrium and it increases with inspiration. | |||
* Severe regurgitation can also present as systolic thrill over the jugular vein. | |||
{{#ev:youtube|VdgA3fcp7Cs}} | |||
===Heart=== | |||
====Palpation==== | |||
* Right ventricular heave or lift may be present due to right ventricular enlargement. | |||
* In presence of [[pulmonary hypertension]], dilated pulmonary artery may result in pulsations felt over the left second intercostal space. | |||
====Auscultation==== | |||
=====Heart Sounds===== | |||
* "[[S3 gallop]]" is present because of right ventricular dilation. | |||
* Fourth heart sound ([[S4]]) may be present because of right ventricular hypertrophy. | |||
* Pulmonic component of second heart sound ([[P2]]) is accentuated if pulmonary hypertension is present. | |||
* Splitting of second heart sound ([[S2]]) may be notable if pulmonary hypertension is present. | |||
{{#ev:youtube|f2WYFIT_09Q}} | |||
{{#ev:youtube|ntNNvRR1U38}} | |||
=====Murmurs===== | |||
* Holosystolic murmur is present. | |||
* Best heard at the right or left fourth intercostal space. | |||
* In presence of right ventricular enlargement, murmur is even audible at the cardiac apex. | |||
* Inspiration, leg raising, exercise and hepatic compression make the murmur loud by increasing venous return to the heart. | |||
* Standing, amyl nitrate and [[valsalva maneuver]] make the murmur soft by decreasing venous return to the heart. | |||
* Diastolic rumble may be present because of increased blood flow across the tricuspid valve during diastole. | |||
{{#ev:youtube|Jk50shI9vV8}} | |||
===Liver=== | |||
* [[Hepatomegaly]] may be present. | |||
* Thrill may be present due to transmission of systolic murmur to liver. | |||
===Lungs=== | |||
* Pulmonary rales might be present if left ventricular dysfunction is associated with the disease. | |||
==2008 and Incorporated 2006 ACC/AHA Guidelines for the Management of Patients with Valvular Heart Disease (DO NOT EDIT) <ref name="pmid18820172">{{cite journal |author=Bonow RO, Carabello BA, Chatterjee K, ''et al.'' |title=2008 Focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease): endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons |journal=Circulation |volume=118 |issue=15 |pages=e523–661 |year=2008 |month=October |pmid=18820172 |doi=10.1161/CIRCULATIONAHA.108.190748 |url=}}</ref>== | ==2008 and Incorporated 2006 ACC/AHA Guidelines for the Management of Patients with Valvular Heart Disease (DO NOT EDIT) <ref name="pmid18820172">{{cite journal |author=Bonow RO, Carabello BA, Chatterjee K, ''et al.'' |title=2008 Focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease): endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons |journal=Circulation |volume=118 |issue=15 |pages=e523–661 |year=2008 |month=October |pmid=18820172 |doi=10.1161/CIRCULATIONAHA.108.190748 |url=}}</ref>== | ||
Revision as of 14:58, 8 September 2014
For the main page of tricuspid regurgitation, click here.
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
On examination, the jugular venous pressure is usually elevated, and 'CV' waves can be seen. The liver may be enlarged and is often pulsatile (the latter finding being virtually diagnostic of tricuspid insufficiency). Peripheral edema is often found. In severe cases, there may be ascites and even cirrhosis (so-called 'cardiac cirrhosis). Tricuspid insufficiency may lead to the presence of a pansystolic heart murmur. Such a murmur is usually of low frequency and best heard low on the left sternal border. It tends to increase with inspiration. However, the murmur may be inaudible reflecting the relatively low pressures in the right side of the heart. A third heart sound may also be present.
Physical Examination
Clinical findings found in patients presenting with tricuspid regurgitation are as a result of right sided heart failure and regurgitant blood flow across the tricuspid valve into the right atria during ventricular contraction. Patients with right sided heart failure may present with peripheral edema, cyanosis, hepatosplenomegaly, ascitis, cachexia and jaundice. Signs of left sided heart failure will dominate in case of left ventricular dysfunction.
Neck
- JVP is prominent and jugular venous distention is present.
- "V wave" is prominent as a result of systolic regurgitation into right atrium and it increases with inspiration.
- Severe regurgitation can also present as systolic thrill over the jugular vein.
{{#ev:youtube|VdgA3fcp7Cs}}
Heart
Palpation
- Right ventricular heave or lift may be present due to right ventricular enlargement.
- In presence of pulmonary hypertension, dilated pulmonary artery may result in pulsations felt over the left second intercostal space.
Auscultation
Heart Sounds
- "S3 gallop" is present because of right ventricular dilation.
- Fourth heart sound (S4) may be present because of right ventricular hypertrophy.
- Pulmonic component of second heart sound (P2) is accentuated if pulmonary hypertension is present.
- Splitting of second heart sound (S2) may be notable if pulmonary hypertension is present.
{{#ev:youtube|f2WYFIT_09Q}}
{{#ev:youtube|ntNNvRR1U38}}
Murmurs
- Holosystolic murmur is present.
- Best heard at the right or left fourth intercostal space.
- In presence of right ventricular enlargement, murmur is even audible at the cardiac apex.
- Inspiration, leg raising, exercise and hepatic compression make the murmur loud by increasing venous return to the heart.
- Standing, amyl nitrate and valsalva maneuver make the murmur soft by decreasing venous return to the heart.
- Diastolic rumble may be present because of increased blood flow across the tricuspid valve during diastole.
{{#ev:youtube|Jk50shI9vV8}}
Liver
- Hepatomegaly may be present.
- Thrill may be present due to transmission of systolic murmur to liver.
Lungs
- Pulmonary rales might be present if left ventricular dysfunction is associated with the disease.
2008 and Incorporated 2006 ACC/AHA Guidelines for the Management of Patients with Valvular Heart Disease (DO NOT EDIT) [1]
Adolescents (DO NOT EDIT) [1]
| Class I |
| "1. Pulse oximetry at rest and/or during exercise is indicated for the initial evaluation of adolescent and young adult patients with TR if an atrial communication is present, and serially every 1 to 3 years, depending on severity. (Level of Evidence: C)" |
Sources
- 2008 ACC/AHA Guidelines incorporated into the 2006 guidelines for the management of patients with valvular heart disease [1]
References
- ↑ 1.0 1.1 1.2 Bonow RO, Carabello BA, Chatterjee K; et al. (2008). "2008 Focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease): endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons". Circulation. 118 (15): e523–661. doi:10.1161/CIRCULATIONAHA.108.190748. PMID 18820172. Unknown parameter
|month=ignored (help)