Tricuspid stenosis physical examination

Vital signs

 * A pulsus paradoxus may be present

Neck

 * An elevated jugular venous pulse may be present

Heart

 * A mid diastolic murmur can be heard during auscultation
 * This is caused by the blood flow through the stenotic valve
 * This is best heard over the left sternal border with rumbling character and tricuspid opening snap with wide splitting S1
 * The murmur of tricuspid stenosis may increase in intensity with inspiration (Carvallo's sign)


 * Jugular Venous Pulse:
 * Sinus rhythm: jugular venous pulse increases and A wave is prominent
 * This may be confused with arterial pulse
 * Atrial fibrillation: A wave is lost


 * Patients with tricuspid stenosis may feature a prominent right atrium palpable to the right of the sternum
 * A tricuspid opening snap may be heard if it not obscured by the sounds of mitral stenosis
 * At either the left sternal border or at the xiphoid process, a diastolic murmur can be heard, increasing with inspiration
 * Tricuspid regurgitation oftentimes presents in a similar location, delineated by a holosystolic murmur

Abdominal

 * Patients frequently experience peripheral edema and ascites

Severity of Disease Presence

 * If patients do not have significant mitral pathology, they will most likely not experience dyspnea
 * Patients may be able to lay flat without symptoms