Tricuspid regurgitation قصور الصمام مثلث الشرف
INSTRUCTION Examine this patient's heart. Examine this patient's cardiovascular system. SALIENT FEATURES History · Intravenous drug abuse. · Trauma to the chest. · Rheumatic lever. · Chronic obstructive puhnonary disease. Examination · Peripheral cyanosis. · Large 'v' waves in the jugular venous pulse. · Left parasternal heave. · Palpable or loud P2. · Pansystolic murmur at the left lower sternal border which increases in inspiration - Carvallo's sign. · Right ventricular third heart sound may be present. · Atrial fibrillation may be present. Look for: - Systolic pulsations of an enlarged liver. - Ascites and ankle oedema. DIAGNOSIS This patient has tricuspid regurgitation (lesion) secondary to chronic lung disease and cor pulmonale (aetiology of the lesion) and is in cardiac failure (functional status). QUESTIONS What are the causes of tricuspid regurgitation? · Functional: pulmonary hypertension, congestive cardiac failure. · Rheumatic (associated with mitral and/or aortic valve disease). · Right heart endocarditis as in drug addicts. · Uncommon causes: carcinoid syndrome, Ebstein's anomaly, endomyocardial fibrosis, infarction of right ventricular papillary muscles, tricuspid valve prolapse, blunt trauma to the heart. How would you treat organic tricuspid regurgitation? Surgically, by valve plication or annuloplasty, or valve replacement. J.M.R. Carvallo, Mexican cardiologist who worked in Mexico City (Rivero-Carvallo JM 1946 Signo para el diagnostico de las insuficiencias tricuspideas. Arch Inst Cardiol Mex 16: 531).