Tricuspid Stenosis
Cardiology (12%) Core Clinical Conditions
1B: Able to identify the condition as a possible diagnosis: may not have the knowledge or resources to confirm the diagnosis or to manage the condition safely, but can take measures to avoid immediate deterioration and refer appropriately
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Definition Aetiology Pathophysiology Risk factor Sign and Symptoms Investigations Management
Definition
Tricuspid stenosis is characterised by a constriction or narrowing of the tricuspid valve. This affects the blood flow between the right atrium and right ventricle (see figure 1).
Figure 1
The narrowing causes less blood to flow through the tricuspid valve.
Aetiology
Rheumatic fever: Inflammation caused by rheumatic fever leads to scarring and thickening of the valve, thereby restricting blood flow through the valve.
Pulmonary hypertension: causes the valve to thicken and scar.
Mitral stenosis
Atrial septal defect
Infectious endocarditis
Pathophysiology
The right atrium attempts to compensate for a constricted tricuspid valve by increasing blood flow through its valve. This, however, causes an increase in atrial pressure and a blood back-up in the liver and other organs. As a result, peripheral edoema, abdominal enlargement, shortness of breath, and fatigue are common symptoms of tricuspid stenosis.
In order to pump more blood through the tricuspid valve, the right ventricle is also overloaded as the disease progresses. This results in ventricular thickening and decreased efficiency. This could ultimately result in heart failure. Additionally, it is essential to understand that blood pooling increases the risk of blood clots.
Risk factors
Rheumatic fever
Congenital heart defect
Infective endocarditis
Sign and symptoms
Peripheral edoema
Abdominal swelling
Shortness of breath
Ankle swelling
Tachycardia
Chest pain
Heart murmur: During mid-diastole, the murmur of tricuspid stenosis is audible at the lower left sternal border.e
Investigations
Echocardiogram
Cardiac catheterization: A catheter is inserted into a blood vessel and guided into the heart during cardiac catheterization. This enables the clinician to measure the pressure in the right atrium and ventricle, as well as visually inspect the tricuspid valve.
MRI
CXR
ECG
Management
If mild/moderate: no treatment, treat underlying condition e.g HF, HTN etc.
Surgery : repair or replacement of tricuspid valve. Transcatheter tricuspid valve replacement (TTVR) is a common procedure done through a catheter.
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