History
Fatigue, due to limited cardiac output, may be present.
Systemic venous congestion leads to abdominal discomfort and swelling. The onset is usually gradual, but it may be rapid if atrial fibrillation or flutter develops. (For related information, see Medscape's Atrial Fibrillation Resource Center).
Dyspnea may be present but is not severe unless concomitant mitral valve disease is present.
Patients may complain about prominent pulsations in the neck.
When tricuspid stenosis occurs concomitantly with mitral stenosis, the decrement of cardiac output to the pulmonary bed may paradoxically diminish the dyspnea, hemoptysis, and orthopnea typically seen with mitral stenosis.
Obtain information regarding preceding rheumatic fever, symptoms of the carcinoid syndrome, and possible congenital abnormalities.
Physical Examination
With sinus rhythm (more common with tricuspid stenosis than with mitral stenosis), the jugular venous pulse increases and the A wave is prominent (may be confused with an arterial pulse).
If atrial fibrillation occurs, the A wave is lost.
Peripheral edema and ascites are frequent.
Without significant mitral pathology, the patient should not be dyspneic and can probably lie flat without symptoms.
A prominent right atrium may be palpable to the right of the sternum. If not obscured by mitral stenosis sounds, a tricuspid opening snap may be heard. A diastolic murmur is audible along the left sternal border or at the xiphoid, which increases with inspiration. Often, tricuspid regurgitation is also present, represented by a holosystolic murmur in a similar location.
The first heart sound may be split widely. The second heart sound may be single. This single sound is due to the inaudible closure of the pulmonary valve from the decrease in blood flow through the stenotic tricuspid valve.
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Tricuspid Stenosis. A representation of a stenotic tricuspid valve. This image demonstrates fusion of the commissures (shown as dotted lines).
