cardiovascular disorders
Tricuspid Stenosis
Symptoms and Signs of Tricuspid Stenosis
The only symptoms of severe tricuspid stenosis are fluttering discomfort in the neck (due to giantawaves in the jugular pulse), fatigue and cold skin (due to low cardiac output), and right upper quadrant abdominal discomfort (due to an enlarged liver). Patients with mild tricuspid stenosis have no symptoms. The primary visible sign is a giant flickeringawave with gradualydescent 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. Soft opening snap Mid-diastolic rumble with presystolic accentuation On auscultation, tricuspid stenosis is often inaudible but may produce a soft opening snap and a mid-diastolic rumble with presystolic accentuation. The murmur becomes louder and longer with maneuvers that increase venous return (exercise, inspiration, leg-raising, Müller maneuver) and softer and shorter with maneuvers that decrease venous return (standing, Valsalva maneuver). Findings of tricuspid stenosis often coexist with those of Mitral Stenosis and are less prominent. The murmurs can be distinguished clinically (see table 