Tricuspid Stenosis is narrowing of the tricuspid valve, causing obstruction of blood flow from the right atrium (RA) to the right ventricle (RV).
Most Common Cause: Rheumatic Heart Disease (RHD) – Always Associated with Mitral Stenosis (MS).
Mnemonic: "TS = Tight Stenosis (of Tricuspid Valve)"
CAUSES OF
TRICUSPID STENOSIS
- Rheumatic Heart Disease (Most Common in India).
- Congenital Tricuspid Stenosis (Rare – Ebstein’s Anomaly).
- Carcinoid Syndrome (Fibrotic Thickening of Right-Sided Valves).
- Infective Endocarditis (Vegetations on Valve).
Mnemonic: "R.C.I.E." (Rheumatic, Congenital, Infection, Endocarditis)
PATHOPHYSIOLOGY
OF TS
- Tricuspid Valve Narrows → Blood Stagnates in RA.
- Right Atrium Enlarges → Systemic Venous Pressure Increases.
- Venous Congestion → Swollen Neck Veins, Liver, Edema, Ascites.
- Late Stage → Right Heart Failure & Low Cardiac Output.
Mnemonic: "N.E.V.L." (Narrowing → Enlarged RA → Venous Congestion → Late Heart Failure)
SYMPTOMS OF
TRICUSPID STENOSIS
- Fatigue & Weakness (Low Blood Output).
- Swelling in Legs, Abdomen (Edema, Ascites).
- Prominent Neck Veins (Jugular Venous Distension).
- Right Upper Abdomen Pain (Due to Liver Congestion).
- Loss of Appetite (GI Congestion).
Mnemonic: "F.S.P.A.L." (Fatigue, Swelling, Prominent JVP, Abdominal Pain, Loss of Appetite)
SIGNS &
MURMURS IN TS
Jugular Venous Pulse (JVP):
- Prominent ‘a’ Wave (Due to RA
Overload).
- Slow ‘y’ Descent (Blood Delayed in RA).
Heart Sounds:
- Loud S1 (Strong Tricuspid Closure
Sound).
- Opening Snap (After Mitral Snap, Heard
in Severe TS).
Murmur:
- Mid-Diastolic Murmur → Best Heard at
Lower Left Sternal Border.
- Murmur Increases with Inspiration
(Carvallo’s Sign – Key Feature of TS).
Mnemonic: "J.O.M." (Jugular ‘a’ Wave, Opening Snap, Mid-Diastolic Murmur)
DIAGNOSIS OF
TRICUSPID STENOSIS
ECG:
- Tall P Waves (Right Atrial Enlargement
– P Pulmonale).
- Atrial Fibrillation (Seen in Advanced
Cases).
Chest X-ray:
- Enlarged Right Atrium.
- Pulmonary Congestion (If Mitral
Stenosis Coexists).
Echocardiography (Best Test!)
- Shows Thickened Tricuspid Valve, Small
Valve Orifice.
Mnemonic: "E.C.E." (ECG, CXR, Echo – Best Test)
TREATMENT OF
TRICUSPID STENOSIS
1. MEDICAL
MANAGEMENT (For Mild-Moderate TS)
- Diuretics (Reduce Swelling & Congestion).
- Salt Restriction (Prevent Fluid Retention).
- Anticoagulants (For Atrial Fibrillation Cases).
Mnemonic: "D.S.A." (Diuretics, Salt Restriction, Anticoagulants)
2. SURGICAL
MANAGEMENT (For Severe TS or Symptoms)
- Balloon Tricuspid Valvuloplasty (BTV) – First Choice!
- Tricuspid Valve Replacement (If Valve is Too Damaged).
Mnemonic: "V.R." (Valvuloplasty or Replacement in Severe TS)
COMPLICATIONS OF
TS
- Right Heart Failure (Severe Venous Congestion).
- Atrial Fibrillation (Due to RA Overload).
- Blood Clots (Risk of Stroke).
Mnemonic: "R.A.B." (Right HF, AFib, Blood Clots)
DIFFERENTIAL
DIAGNOSIS (CONDITIONS THAT MIMIC TS)
- Mitral Stenosis (MS): Murmur Heard at Apex, Not Right-Sided.
- Constrictive Pericarditis: Kussmaul’s Sign Positive (JVP Does Not Fall on Inspiration).
- Right Atrial Myxoma: Tumor Blocks Tricuspid Valve.
Mnemonic: "M.C.R." (Mitral Stenosis, Constrictive Pericarditis, RA Myxoma)
PREVENTION OF
TRICUSPID STENOSIS
- Early Treatment of Rheumatic Fever (Penicillin Prophylaxis).
- Regular Follow-up for Valve Disease.
- Control Pulmonary Hypertension.
Mnemonic: "P.R.C." (Penicillin, Regular Check-ups, Control Pulmonary HTN)
FINAL REVISION WITH MNEMONICS
- Definition = "TS = Tight Stenosis (of Tricuspid Valve)"
- Causes = "R.C.I.E." (Rheumatic, Congenital, Infection, Endocarditis)
- Pathophysiology = "N.E.V.L." (Narrowing → Enlarged RA → Venous Congestion → Late Heart Failure)
- Symptoms = "F.S.P.A.L." (Fatigue, Swelling, Prominent JVP, Abdominal Pain, Loss of Appetite)
- Signs & Murmurs = "J.O.M." (Jugular ‘a’ Wave, Opening Snap, Mid-Diastolic Murmur)
- Diagnosis = "E.C.E." (ECG, CXR, Echo – Best Test)
- Medical Treatment = "D.S.A." (Diuretics, Salt Restriction, Anticoagulants)
- Surgical Treatment = "V.R." (Valvuloplasty or Replacement in Severe TS)
- Complications = "R.A.B." (Right HF, AFib, Blood Clots)
- Differential Diagnosis = "M.C.R." (Mitral Stenosis, Constrictive Pericarditis, RA Myxoma)
- Prevention = "P.R.C." (Penicillin, Regular Check-ups, Control Pulmonary HTN)
.png)