Tricuspid regurgitation differential diagnosis: Difference between revisions

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{{Tricuspid regurgitation}}
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==Overview==
==Overview==
The blowing [[holosystolic murmur]] of tricuspid regurgitation must be distinguished from [[mitral regurgitation]] and a [[ventricular septal defect]].
The blowing [[holosystolic murmur]] of tricuspid regurgitation must be distinguished from the murmur of [[mitral regurgitation]] and a [[ventricular septal defect]].


==Differentiating Tricuspid regurgitation from other Diseases==
==Differentiating Tricuspid regurgitation from other Diseases==
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|'''Tricuspid Regurgitation'''
|'''Tricuspid Regurgitation'''
|'''Mitral Regurgitation'''
|'''Mitral Regurgitation'''
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*Can be best heard over the fourth intercostal area at left sternal border.
*Can be best heard over the fourth intercostal area at [[left sternal border]].
*The intensity can be accentuated following inspiration ([[Carvallo's sign]]) due to increased regurgitant flow in [[right ventricular]] volume.
*The intensity can be accentuated following [[inspiration]] ([[Carvallo's sign]]) due to increased regurgitant flow in [[right ventricular]] volume.
*Tricuspid regurgitation is most often secondary to [[pulmonary hypertension]].
*Tricuspid regurgitation is most often secondary to [[pulmonary hypertension]].
*Primary tricuspid regurgitation is less common and can be due to bacterial [[endocarditis]] following IV drug use, [[Ebstein's anomaly]], [[carcinoid disease]], or prior [[right ventricular infarction]].
*Primary tricuspid regurgitation is less common and can be due to bacterial [[endocarditis]] following [[IV drug use]], [[Ebstein's anomaly]], [[carcinoid disease]], or prior [[right ventricular infarction]].
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*The murmur in [[mitral regurgitation]] is high pitched and best heard at the [[apex]] with diaphragm of the stethoscope with patient in the lateral decubitus position.  
*The [[murmur]] in [[mitral regurgitation]] is high pitched and best heard at the [[apex]] with diaphragm of the [[stethoscope]] with patient in the lateral decubitus position.  
*Left ventricular function can be assessed by determining the apical impulse.  
*[[Left ventricular function]] can be assessed by determining the [[apical impulse]].  
*A normal or hyperdynamic apical impulse suggests good ejection fraction and primary [[mitral regurgitation]].  
*A normal or hyperdynamic [[apical impulse]] suggests good [[ejection fraction]] and primary [[mitral regurgitation]].  
*A displaced and sustained apical impulse suggests decreased ejection fraction and chronic and severe [[mitral regurgitation]].
*A displaced and sustained [[apical impulse]] suggests decreased [[ejection fraction]] and chronic and severe [[mitral regurgitation]].
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*The holosystolic murmur can be best heard over the left third and fourth intercostal spaces and along the sternal border.
*The [[holosystolic murmur]] can be best heard over the left third and fourth intercostal spaces and along the sternal border.
*When the shunt becomes reversed ([[Eisenmenger's syndrome]]), the murmur may be absent and S<sub>2</sub> can become markedly accentuated and single.
*When the shunt becomes reversed ([[Eisenmenger's syndrome]]), the murmur may be absent and S<sub>2</sub> can become markedly accentuated and single.
|Severe TR has been documented to mimic some hemodynamic findings in constrictive pericarditis, with right heart catheterization demonstrating a constrictive physiology. Echocardiography, CT thorax, and cardiac MRI useful for ruling out pericardial pathology.
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*Severe TR has been documented to mimic some hemodynamic findings in [[constrictive pericarditis]], with [[right heart catheterization]] demonstrating a constrictive physiology. [[Echocardiography]], CT thorax, and [[cardiac MRI]] are useful for ruling out [[pericardium|pericardial]] pathology.
 
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==References==
==References==
{{Reflist|2}}
{{Reflist|2}}


[[Category:Valvular heart disease]]
[[Category:Cardiology]]
[[Category:Cardiology]]
[[Category:Disease]]
[[Category:Cardiac surgery]]
[[Category:Overview complete]]


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Latest revision as of 17:52, 21 January 2020

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Fatimo Biobaku M.B.B.S [2]

Overview

The blowing holosystolic murmur of tricuspid regurgitation must be distinguished from the murmur of mitral regurgitation and a ventricular septal defect.

Differentiating Tricuspid regurgitation from other Diseases

Tricuspid Regurgitation Mitral Regurgitation VSD Constrictive Pericarditis[1]
  • The holosystolic murmur can be best heard over the left third and fourth intercostal spaces and along the sternal border.
  • When the shunt becomes reversed (Eisenmenger's syndrome), the murmur may be absent and S2 can become markedly accentuated and single.


References

  1. Ozpelit E, Akdeniz B, Ozpelit ME, Göldeli O (2014). "Severe tricuspid regurgitation mimicking constrictive pericarditis". Am J Case Rep. 15: 271–4. doi:10.12659/AJCR.890092. PMC 4079647. PMID 24995118.

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