Tricuspid stenosis history and symptoms

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Syed Musadiq Ali M.B.B.S.[2]

Overview

Tricuspid stenosis is mostly associated with mitral valve abnormalities. Common symptoms include dyspnea, peripheral edema, and fatigue. Tricuspid stenosis (TS) is the narrowing of the tricuspid orifice that obstructs blood flow from the right atrium to the right ventricle. Almost all cases result from rheumatic fever. Symptoms include a fluttering discomfort in the neck, fatigue, cold skin, and right upper quadrant abdominal discomfort. Jugular pulsations are prominent, and a presystolic murmur is often heard at the left sternal edge in the 4th intercostal space and is increased during inspiration. The diagnosis is by echocardiography. TS is usually benign, requiring no specific treatment, but symptomatic patients may benefit from surgery.

History and Symptoms

Tricuspid stenosis is almost always due to rheumatic fever; tricuspid regurgitation is almost always also present, as is rheumatic mitral valvulopathy.^[1]^[2]
Rare causes of tricuspid stenosis include systemic lupus erythematosus, right atrial myxoma, congenital malformations, and metastatic tumors.
The right atrium becomes hypertrophied and distended, and sequelae of right heart disease-induced heart failure develop but without right ventricular (RV) dysfunction; the RV remains underfilled and small.
Uncommonly, atrial fibrillation occurs.

Common symptoms of tricuspid stenosis include:^[3]^[4]^[5]

The only symptoms of severe tricuspid stenosis are fluttering discomfort in the neck (due to giant a waves in the jugular pulse), fatigue and cold skin (due to low cardiac output), and right upper quadrant abdominal discomfort (due to an enlarged liver)^[6]
Out of proportion to dyspnea

The primary visible sign is a giant flickering a wave with gradual y descent in the jugular veins
Jugular venous distention may occur, increasing with inspiration (Kussmaul sign)
The face may become dusky and scalp veins may dilate when the patient is recumbent (suffusion sign)
Hepatic congestion and peripheral edema may occur

Less common symptoms of tricuspid stenosis include:^[1]^[7]

References

↑ ^1.0 ^1.1 Roguin A, Rinkevich D, Milo S, Markiewicz W, Reisner SA (1998). “Long-term follow-up of patients with severe rheumatic tricuspid stenosis”. Am Heart J. 136 (1): 103–8. PMID 9665226 PMID: 9665226 Check |pmid= value (help).
↑ Hirata K, Tengan T, Wake M, Takahashi T, Ishimine T, Yasumoto H, Nakasu A, Mototake H (September 2019). “Bioprosthetic tricuspid valve stenosis: a case series”. Eur Heart J Case Rep. 3 (3). doi:10.1093/ehjcr/ytz110. PMC 6764547 Check |pmc= value (help). PMID 31367735.
↑ Coffey S, Rayner J, Newton J, Prendergast BD (2014). “Right-sided valve disease”. Int J Clin Pract. 68 (10): 1221–6. doi:10.1111/ijcp.12485. PMID 25269950.
↑ Fisher J (1984). “Jugular venous valves and physical signs”. Chest. 85 (5): 685–6. doi:10.1378/chest.85.5.685. PMID 6713978.
↑ Walker HK, Hall WD, Hurst JW (1990). “Clinical Methods: The History, Physical, and Laboratory Examinations”. PMID 21250143.
↑ Golamari R, Bhattacharya PT. PMID 29763166. Missing or empty |title= (help)
↑ KOSSMANN CE (March 1955). “The opening snap of the tricuspid valve: a physical sign of tricuspid stenosis”. Circulation. 11 (3): 378–90. doi:10.1161/01.cir.11.3.378. PMID 14352381.

Overview