Makindo Medical Notes"One small step for man, one large step for Makindo" |
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The more esoteric relations with right-sided valve disease always makes me think of drug addicts and endocarditis, carcinoid syndrome and former congenital heart disease as well as the usual expected causes.
Form of Pulmonary Valve Disease | Clinical Presentation | Important Clinical Signs | Investigations | Management |
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Pulmonary Stenosis | Dyspnoea on exertion, fatigue, syncope (in severe cases), right heart failure |
- Ejection systolic murmur at left upper sternal border
- Right ventricular heave - Split second heart sound (S2) - Cyanosis in severe cases |
Echocardiogram, ECG (RVH), Chest X-ray | Balloon valvuloplasty, Surgical valve repair or replacement in severe cases |
Pulmonary Regurgitation | Dyspnoea, fatigue, right heart failure |
- Early diastolic murmur (decrescendo) at left upper sternal border
- Wide splitting of S2 - Right ventricular heave - Signs of right heart failure (e.g., peripheral oedema, raised JVP) |
Echocardiogram, ECG, Chest X-ray, Cardiac MRI | Observation in mild cases, Surgical valve repair/replacement in severe cases |
Form of Tricuspid Valve Disease | Clinical Presentation | Important Clinical Signs | Investigations | Management |
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Tricuspid Stenosis | Fatigue, right heart failure, abdominal discomfort, ascites |
- Mid-diastolic murmur at left lower sternal border
- Raised jugular venous pressure (JVP) - Hepatomegaly - Peripheral oedema |
Echocardiogram, ECG, Chest X-ray, Cardiac catheterization | Medical management (diuretics), Surgical valve repair/replacement if severe |
Tricuspid Regurgitation | Fatigue, abdominal swelling, peripheral oedema, ascites |
- Pansystolic murmur at left lower sternal border, increases with inspiration (Carvallo’s sign)
- Elevated JVP with prominent v-waves - Hepatomegaly - Peripheral oedema, ascites |
Echocardiogram, ECG, Chest X-ray | Medical management (diuretics), Surgical repair/replacement in severe cases |