Difference between revisions of "Tricuspid regurgitation differential diagnosis"

Jump to: navigation, search
(Differentiating Tricuspid regurgitation from other Diseases)
Line 23: Line 23:
 
*[[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]].
 +
|
 +
*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.
 +
|}
 +
 +
{| 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]].
 
*A displaced and sustained [[apical impulse]] suggests decreased [[ejection fraction]] and chronic and severe [[mitral regurgitation]].
 
|
 
|

Revision as of 18:52, 17 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]

Home logo1.png

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.
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. 1.0 1.1 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.



Linked-in.jpg