Tricuspid regurgitation differential diagnosis: Difference between revisions

Jump to navigation Jump to search
 
(One intermediate revision by the same user not shown)
Line 29: Line 29:
|
|
*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.
*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.
|}
|}<br />
 
{| border="1"
|- style="padding: 0 5px; font-size: 100%; " align="center"
|'''Tricuspid Regurgitation'''
|'''Mitral Regurgitation'''
|'''VSD'''
|'''Constrictive Pericarditis'''<ref name="pmid24995118" />
|- style="font-size: 100; padding: 0 5px;"
|
*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.
*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]].
|
*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]].
*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]].
|
*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.
|
*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.
|}
 
==References==
==References==
{{Reflist|2}}
{{Reflist|2}}

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.

Template:WH Template:WS