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Question
23 out of 30
 

True about TS is (AIIMS May 2010)



A Giant a wave and slow y descent

B Giant a wave and prominent y descent

C Giant a wave and slow x descent

D Giant a wave and prominent x descent

Ans. A

Giant a wave and slow y descent

Tricuspid regurgitation

Causes:

1. Functional (Commonest cause of TR) seen in cor-pulmonale Q

2. Pulmonary hypertension

3. RHD

4. Infective endocarditis (IV drug abusers) Q

5. Carcinoid syndrome

6. Ebstein’s Q anomaly


Symptoms: Fatigue; hepatic pain on exertion; ascites; edema.

Signs:

Giant v wavesQ, prominent y descent Q in JVP, RV heave; pansystolic murmur Q, heard best at lower sternal edge in inspiration; pulsatile hepatomegalyQ; jaundice; ascites

Management: Treat underlying cause.

Drugs: diuretics, digoxin, ACE-inhibitors. Valve replacement (20% operative mortality).

Extra Edge: (Hari- 18th Pg 1828)

The murmur of TR is loudest at the lower left sternal border, increases in intensity with inspiration (Carvallo's sign), and is accompanied by visible cv waves in the jugular venous wave form and, on occasion, by pulsatile hepatomegaly.

Controversy about Carvallo’s sign: In different editions of Harrison

1. The Pan systolic murmur of TR is loudest at the lower left sternal border, increases in intensity with inspiration (Carvallo's sign). (Harrison 18th edition Pg 1828, 1914, 1931)

2. Tricuspid regurgitation with normal pulmonary artery pressures, such as that caused by infective endocarditis in injection drug users, may produce an early systolic murmur. The murmur is soft, best heart at the lower left sternal edge, and may accentuate with inspiration (Carvallo's sign). (Harrison, 15th edition, Pg- 1008)

3. In Tricuspid Stenosis there is diastolic murmur. The murmur is augmented during inspiration and reduce in expiration when tricuspid blood flow is reduce this is known as (Carvallo's sign). (Harrison, 12th edition, Pg- 951)

Tricuspid stenosis

Causes:

1. RHD; almost always occurs with mitral or aortic valve disease.

2. Symptoms: Fatigue, ascites, oedema.

3. Signs: Giant a wave Q and slow y descent Q in JVP, diastolic murmur Q heard at the left sternal edge in inspiration.

Diagnosis: Doppler echo.

Treatment: Diuretics; surgical repair.

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