Ebstein's anomaly of the tricuspid valve physical examination

and Claudia P. Hochberg, M.D. [mailto:chochber@bidmc.harvard.edu]

Associate Editor-In-Chief: }; Keri Shafer, M.D. [mailto:kshafer@bidmc.harvard.edu] Priyamvada Singh, MBBS mailto:psingh@perfuse.org

Assistant Editor-In-Chief: Kristin Feeney, B.S. mailto:kfeeney@perfuse.org

Physical Examination
General Appearance

Patients may have a bluish coloration of their face depending on the degree of cyanosis and right to left shunting.

Heart
Inspection -


 * Tricuspid regurgitation and increased right atrial pressure may cause an increase in jugular venous pressure. Prominent "a" wave in the distended jugular veins can be seen in these patients. In cases of severe tricuspid regurgitation, a prominent "v" wave may be seen.
 * The chest may be asymmetric due to an enlarged right heart.
 * Apical impulses could be appreciated

Palpation-


 * Hepatomegaly may be seen as a result of tricuspid regurgitation and elevated right atrial pressure.
 * Palpable prominent diffuse apical impulse
 * Systolic thrill at the left lower sternal border

Auscultation


 * Widely split first and second heart sounds, due to right bundle branch block seen with this condition.
 * Prominent S3 and S4 may be appreciated (multiple heart sound).
 * Holosystolic murmur from tricuspid regurgitation, heard best along the left lower sternal border and increases with inspiration.
 * Mid-diastolic murmur due to the high diastolic flow volume across the tricuspid valve.