Tricuspid regurgitation differential diagnosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

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Overview

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

Differentiating Mitral regurgitation from other Diseases

Tricuspid Regurgitation Mitral Regurgitation VSD
  • 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 S2 can become markedly accentuated and single.

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