Diagnosis

Tricuspid stenosis

Etiology

Cause [ipt][5te]

• Iatrogenic (postsurgery, fibrosis due to pacemaker leads)

• Congenital tricuspid deformities (Ebstein anomaly, Fabry and Whipple diseases)

• Acquired:

  • Late complication of acute rheumatic fever (90%) [vs6]

  • Carcinoid syndrome

  • Systemic lupus erythematosis

  • Myxoma

  • Antiphospholipid antibody syndrome

  • Endocarditis

  • Hypereosinophilic syndrome

  • Endomyocardial fibrosis

  • Metastatic tumors

Pathophysiology [ipt]

1. Stenosis of the tricuspid valves --> elevated pressure in the right atrium during diastolic filling of the right ventricle

2. The right atrium hypertrophies and distends

3. The right ventricle remains underfilled and small

4. Heart failure --> reduced cardiac output --> systemic congestion:

   • Dyspnea

   • Fatigue/weakness

   • Exertional syncope

Complications [ipt]

• Atrial fibrillation

• Heart failure

• Liver failure

• Infective endocarditis

Epidemiology

Prevalence per 100.000 [ghh][vs6]

Approach

• Blood test

• ECG

• Chest X-ray

• Echocardiography

• Cardiac catheterisation

• Cardiac MRI or CT angiography

Treatment

1. Medical treatment: [ipt][5te]

   • Treatment of the underlying condition

   • Loop diuretics --> relieve systemic and hepatic congestion

2. Percutaneous valvotomy if absence of tumor, thrombus, vegetation, and insignificant or mild tricuspid regurgitation.

3. Surgical correction (repair or replacement) if coexisting valvular heart diseases, such as mitral stenosis

Differential diagnoses

Aortic stenosis, Cardiomyopathy, Endocarditis, Endomyocardial fibrosis, Mitral regurgitation, Mitral stenosis, Myxoma, Pericarditis, Pulmonary embolism, Systemic lupus erythematosus, Tricuspid regurgitation