Tricuspid stenosis physical examination

Normally, tricuspid stenosis co-exists with mitral stenosis,thus depending on the severity of mitral valve pathology, symptoms differ. Since these two diseases often coexist, the diagnosis of tricuspid stenosis may be missed. Patients can lay flat without any symptoms in the absence of serious mitral valve pathology and thus, not present with any signs of dyspnea. Characteristic findings of tricuspid stenosis include an opening snap and a diastolic rumbling murmur that is localized to the left sternal border, at the fourth intercostal space and it increases with inspiration.

• An elevated jugular venous pulse may be present.^[1][2]
• “A wave” is prominent due to the jugular venous pulsation (Don’t get confused with arterial pulsation).
• Kussmaul’s sign is positive.
• Jugular presystolic click may be heard.
• “Y descent” is slow.^[3]

• 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^[4].

• Mid diastolic murmur^[5].
• The murmur 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 increases in intensity with inspiration (Carvallo’s sign), leg raising, squatting and exercise, due to the increased blood flow across the tricuspid valve during these maneuvers.
• Tricuspid regurgitation oftentimes presents in a similar location, it is delineated by a holosystolic murmur.

• Patients may experience hepatomegaly and ascites^[6].

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