Ebsteins anomaly of the tricuspid valve physical examination

Ebsteins anomaly of the tricuspid valve Microchapters
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] and Claudia P. Hochberg, M.D. [2]

Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [3]}; Keri Shafer, M.D. [4] Priyamvada Singh, MBBS [[5]] Assistant Editor-In-Chief: Kristin Feeney, B.S. [[6]]

Physical Examination

Appearance

Patients may have a bluish coloration of their face depending on the degree of cyanosis and right to left shunting.

Heart

Inspection

• Tricuspid regurgitation and increased right atrial pressure may cause an increase in jugular venous pressure. Prominent "a" wave in the distended jugular veins can be seen in these patients. In cases of severe tricuspid regurgitation, a prominent "v" wave may be seen.
• The chest may be asymmetric due to an enlarged right heart.
• Apical impulses could be appreciated
• Elevated jugular venous distension

Palpation

• Hepatomegaly may be seen as a result of tricuspid regurgitation and elevated right atrial pressure.
• Palpable prominent diffuse apical impulse
• Systolic thrill at the left lower sternal border
• Right venrticle lift is subtle due to small right ventricle

Auscultation

• Widely split first and second heart sounds, due to right bundle branch block seen with this condition.
• Loud 1st heart sound of tricuspid regurgitation
• Prominent S3 and S4 may be appreciated (multiple heart sound).
• Holosystolic murmur from tricuspid regurgitation, heard best along the left lower sternal border and increases with inspiration.** Mid-diastolic murmur due to the high diastolic flow volume across the tricuspid valve
• Clicks sound are heard due to anterior leaflet.

Extremities

• Clubbing
• Cyanosis
• Cool periphery