Tricuspid regurgitation
Pan-systolic murmur - split second heart sound due to the pulmonary valve closing earlier than aortic as the right ventricle empties fast than left
Other signs of tricuspid regurgitation:
- Thrill in the tricuspid area on palpation
- Raised JVP with giant C-V waves (Lancisi’s sign)
- Pulsatile liver (due to regurgitation into the venous system)
- Peripheral oedema
- Ascites
Causes of tricuspid regurgitation:
- Pressure due to left-sided heart failure or pulmonary hypertension (“functional”)
- Infective endocarditis
- Rheumatic heart disease
- Carcinoid syndrome
- Ebstein’s anomaly
- Connective tissue disorders, such as Marfan syndrome
Pulmonary stenosis
Ejection systolic murmur heard better in deep inspiration Widely split second heart sound for the same reason as above.
Usually congenital - Tetralogy of Fallotand Noonan syndrome
Signs of pulmonary stenosis:
- Thrill in the pulmonary area on palpation
- Raised JVP with giant A waves (due to the right atrium contracting against a hypertrophic right ventricle)
- Peripheral oedema
- Ascites
Tetralogy of Fallot
- Ventricular septal defect (VSD)
- Overriding aorta
- Pulmonary valve stenosis
- Right ventricular hypertrophy