Tricuspid valve stenosis is rarely a condition solely responsible for the symptoms reported by affected patients. Isolated tricuspid valve stenosis and congenital type of the disorder are very rare [1]. Symptoms accompanying tricuspid valve stenosis are elicited by the condition in question, and also by mitral and aortic valve diseases, as these pathologies tend to be closely linked together [2].

For these reasons, symptomatology separately caused by tricuspid valve stenosis is difficult to be defined precisely. Nevertheless, patients who are diagnosed with the condition tend to present with the following symptoms [3] [4]:

• Fatigue
• Dyspnea
• Abdominal discomfort and ascites, due to systemic venous congestion
• Pulsations felt by the patient at the neck area
• Peripheral edema

• Fatigue

  Symptoms of tricuspid regurgitation may include decreased urination, fatigue, swelling in the abdomen, feet or ankles and abnormal pulsing experienced in the neck veins. [emoryhealthcare.org]

  Symptoms include a fluttering discomfort in the neck, fatigue, cold skin, and right upper quadrant abdominal discomfort. [msdmanuals.com]

  Symptoms are usually mild but include palpitations (awareness of heartbeats), a fluttering discomfort in the chest, cold skin and fatigue. Medical management usually includes drug treatment and regular doctor exams. [heart.org]

  Heart disease - Right atrial tumor thrombus Less common causes of TS- - Regional Tamponade - Systemic Lupus - Intracardiac wires - Prosthetic heart valve - Endocarditis Patient symptoms and Physical Examination: - signs and symptoms of MS- - Dyspena - Fatigue [quizlet.com]

• Pain

  As such, pastoral caregiver helps the mourner to (re)form the relational self, while both listening empathically the voice of mourner and paying attention to the painful situation. [dbpia.co.kr]

  Tricuspid Valve Disease Heart Throat pain Difficulty swallowing Red and swollen tonsils Tiny red spots on the soft or hard palate Swollen, tender lymph glands Fever Headache Rash Stomach ache Fatigue Shortness of breath Palpitations Chest pain Vomitting [nm.org]

  Over time, there may be pain in the upper right abdomen due to increased congestion and enlargement of the liver. [schmidtandclark.com]

  Over time, there may be pain in the upper right abdomen, due to increased congestion and enlargement of the liver. [medical-dictionary.thefreedictionary.com]

  Symptoms typically develop when narrowing of the valve is severe and can include: Chest pain (angina) or tightness Feeling faint or fainting with exertion Shortness of breath Fatigue Heart palpitations — sensations of a rapid, fluttering heartbeat Heart [schmidtlaw.com]

• Ascites

  Right upper quadrant Pain - Anasarca - flutter feeling in the neck - Hepatomegaly - Jaundice - jugular venous distention - Peripheral edema without pulmonary congestion - peripheral edema - Hepatomegaly - Jugular venous distention - ascites - cyanosis [quizlet.com]

  Nevertheless, patients who are diagnosed with the condition tend to present with the following symptoms: Fatigue Dyspnea Abdominal discomfort and ascites, due to systemic venous congestion Pulsations felt by the patient at the neck area Peripheral edema [symptoma.com]

  The result is chronic hepatic congestion and hepatomegaly along with peripheral edema and ascites. [pathwaymedicine.org]

  Ascites with diaphragmatic elevation may be present. Pulmonary arterial and venous hypertension are common. [patient.info]

• Falling

  This increased pressure gradient is expressed as an increase in the pressure proximal to the valve and a small fall in pressure distal to the valve. [cvphysiology.com]

  Heart valve problems fall into two major categories: Stenosis – The opening of the valve is too narrow, and this interferes with the forward flow of blood Regurgitation – The valve doesn't close properly. [health.harvard.edu]

  When catheterization is indicated (eg, to evaluate coronary anatomy), findings include elevated RA pressure with a slow fall in early diastole and a diastolic pressure gradient across the tricuspid valve. [msdmanuals.com]

  Your treatment could include: Monitoring – If your tricuspid valve stenosis falls within the mild to moderate category, your physician may decide to just watch it carefully through occasional medical appointments. [heart-valve-surgery.com]

• Noncompliance

  In patients with sudden onset of mitral regurgitation, a relatively noncompliant left atrium leads to large V waves. [tele.med.ru]

• Exertional Dyspnea

  […] end-systolic volume収縮終（末）期容積、期末容積 end-to-end anastomosis端々吻合 end-to-side anastomosis端側吻合 epicardial心外膜　【形】 epicardium心外膜 ergometer exerciseエルゴメータ運動負荷 escaped beat補充収縮 escaped rhythm補充調律 evoked potential誘発電位 excitation-contraction (E-C) coupling興奮収縮連関 exertional [tokyo-med.ac.jp]

  […] on exertion, orthopnea, fatigue, and occasionally paroxysmal nocturnal dyspnea. [textbookofcardiology.org]

• Common Cold

  Common Symptoms The most common symptoms associated with tricuspid valve stenosis include: Lethargy Tiredness Frailty Dilated scalp veins Cold skin caused by low cardiac output Irregular rapid heartbeats (atrial fibrillation palpitations) Quivering sensations [rosenfeldinjurylawyers.com]

• Regurgitation

  In Part II, conditions producing pure tricuspid regurgitation are discussed. In contrast to the relatively few causes of tricuspid stenosis, the causes of pure (no element of stenosis) tricuspid regurgitation are multiple. [ncbi.nlm.nih.gov]

  Tricuspid valve disease, rheumatic Tricuspid valve regurgitation Tricuspid valve regurgitation, rheumatic Tricuspid valve stenosis, rheumatic Clinical Information Incomplete closure of the tricuspid valve, resulting in tricuspid regurgitation; it is [icd9data.com]

  Learn more about a minimally invasive treatment option for tricuspid valve stenosis or regurgitation [emoryhealthcare.org]

• Abdominal Pain

  Symptoms may include: Edwards MC 3 Annuloplasty System Irregular heart rhythm (atrial fibrillation) Easily tired (fatigue) A fluttering discomfort in the neck With severe disease, heart failure symptoms (right abdominal pain, shortness of breath, swelling [my.clevelandclinic.org]

  Symptoms include dyspnea on exertion, light-headedness, lethargy, peripheral edema, chest pain, palpitations, and abdominal pain. [textbookofcardiology.org]

• Heart Disease

  Bonow help you to apply all of the latest scientific knowledge and clinical strategies with Valvular Heart Disease, a companion to Braunwald’s Heart Disease. [books.google.com]

  […] valves in patients with rheumatic heart disease. 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: Executive Summary [21] Class IIb " 1. [wikidoc.org]

  Tricuspid stenosis rarely occurs in isolation, and usually presents when there is already significant mitral stenosis in the setting of rheumatic heart disease 1-3. [radiopaedia.org]

  Rheumatic heart disease is still a common cardiac disease in developing countries. Triscupid valve is not usually involved in RHD and whenever it is involved, it is always associated with mitral valve disease. [ncbi.nlm.nih.gov]

  As with all valvular heart diseases, echocardiography is key to making the diagnosis and assessing the severity. [wikiecho.org]

• Heart Murmur

  The main sign of heart valve disease is an unusual heartbeat sound called a heart murmur. Your doctor can hear a heart murmur with a stethoscope. But many people have heart murmurs without having a problem. [icdlist.com]

  The diagnosis of tricuspid valve stenosis usually occurs during a physical examination with the discovery of a heart murmur. Additional testing is usually performed after the discovery of a heart murmur. [rahmanicardiology.com]

  A heart murmur had been diagnosed 28 years previously, and she had been followed at the Hospital for Sick Children, Toronto. She remained entirely symptom free during adolescence. .. [nejm.org]

  A heart murmur produced by blood trying to flow through a stenotic valve can be heard with a stethoscope, and an x ray of the chest will show the right atrium to be enlarged. [schmidtandclark.com]

• Opening Snap

  Soft opening snap Mid-diastolic rumble with presystolic accentuation On auscultation, tricuspid stenosis is often inaudible but may produce a soft opening snap and a mid-diastolic rumble with presystolic accentuation. [msdmanuals.com]

  It is best heard over the left sternal border with rumbling character and tricuspid opening snap with wide-splitting S1. It may increase in intensity with inspiration (Carvallo's sign). [en.wikipedia.org]

  snap- (may occur later than MV opening snap) - Diastolic rumble heard best at apex - Both of these sounds may be accentuated with inspiration as it increases flow to the right heart. - Physician may describe a pre systolic click with atrial contraction [quizlet.com]

• Diastolic Murmur

  A mild diastolic murmur can be heard during auscultation caused by the blood flow through the stenotic valve. It is best heard over the left sternal border with rumbling character and tricuspid opening snap with wide-splitting S1. [en.wikipedia.org]

  Clinical examination classically reveals an elevated jugular venous pressure with a dominant a-wave and slow y-descent, and a mid-diastolic murmur that is heard on praecordial auscultation 1-3. [radiopaedia.org]

  Mitral valve stenosis is associated with a diastolic murmur because of turbulence that occurs as blood flows across the stenotic valve.. [cvphysiology.com]

  Mitral regurgitation : The murmur of mitral regurgitation is blowing, soft and best heard at the apex. Mitral stenosis : The murmur of mitral stenosis is mid-diastolic, rumbling, and best heard after the opening snap. [wikidoc.org]

  A low rumbling diastolic murmur along the left sternal border, which increases with inspiration. Tricuspid regurgitation is often also present, causing a pansystolic murmur in a similar location. [patient.info]

• Jugular Venous Distention

  venous distention - Peripheral edema without pulmonary congestion - peripheral edema - Hepatomegaly - Jugular venous distention - ascites - cyanosis - fatigue - Sounds like mitral stenosis - Opening snap- (may occur later than MV opening snap) - Diastolic [quizlet.com]

  The primary visible sign is a giant flickering a wave with gradual y descent in the jugular veins. Jugular venous distention may occur, increasing with inspiration (Kussmaul sign). [msdmanuals.com]

  Isolated tricuspid stenosis is manifest by the signs and symptoms of right-sided heart failure, including hepatomegaly, hepatic dysfunction, ascites, edema, and jugular venous distention with giant A waves visible on the central venous pressure recording [tele.med.ru]

• Hepatomegaly

  Jaundice - jugular venous distention - Peripheral edema without pulmonary congestion - peripheral edema - Hepatomegaly - Jugular venous distention - ascites - cyanosis - fatigue - Sounds like mitral stenosis - Opening snap- (may occur later than MV [quizlet.com]

  The result is chronic hepatic congestion and hepatomegaly along with peripheral edema and ascites. [pathwaymedicine.org]

  Patients with tricuspid stenosis characteristically present with right-predominant clinical features of heart failure such as hepatomegaly, ascites, and anasarca 1-3. [radiopaedia.org]

  Blood flow into the pulmonary circulation is impaired and is accompanied by peripheral oedema and hepatomegaly. [patient.info]

  Signs and Symptoms [19] Fatigue Dyspnea Abdominal discomfort (due to hepatomegaly secondary to systemic venous congestion) Pedal edema Jugular venous distension Heart murmur Physical Examination Tricuspid stenosis often co-exists with mitral stenosis, [wikidoc.org]

• Irritability

  […] with valvular regurgitation. 1 Interestingly, there have been reports of cases of tricuspid stenosis without associated valvular regurgitation, most of them pacemaker lead-induced. 2 The pathophysiology of this tricuspid stenosis includes mechanical irritation [revportcardiol.org]

  To prevent the imminent rupture and the acute occurrence of a significant left-to-right-shunt on the ventricular level, as well as increasing irritation of tricuspid valve, an elective operation was performed. [dict.cnki.net]

Due to symptoms caused by tricuspid valve stenosis and coexistent conditions being considerably non-specific, the complete workup for the diagnosis of tricuspid valve stenosis is extensive. It includes echocardiography, chest X-rays, computerized tomography (CT), and magnetic resonance imaging (MRI). Cardiac catheterization may also be indicated.

The imaging modality that is most effective in the diagnosis of tricuspid valve stenosis is the echocardiography. It can illustrate abnormal structural changes within the valvular orifice, such as thickening and fusion of leaflets, a diminished annulus diameter, and an increased blood velocity through the valve. It is also invaluable in detecting any other associated cardiac condition [5]. Calcification of the tricuspid valve, diastolic doming, and signs compatible with the enlargement of the right atrium are findings that agree with the diagnosis of tricuspid valve stenosis [6]. A continuous-wave Doppler ultrasound can measure transvalvular velocities which can be utilized to calculate the mean pressure gradient. In patients affected by serious tricuspid valve stenosis, the mean pressure gradient exceeds 5 mmHg [7] [8] [9].

Plain radiography of the chest can help to observe a potentially enlarged heart. The enlargement of the right atrium may be particularly pronounced. CT of the heart typically illustrates fused and abnormally thick leaflets while MRI is able to confirm the existence of diastolic doming and a restriction in the process of valvular opening. Cardiac catheterization may be used to aid in the planning of the optimal surgical procedure, as it can diagnose many aspects of cardiac pathology.

• Prominent A-Wave

  Patients often display a prominent A Wave as atrial systole against the stenotic tricuspid valve results in an exaggerated increase in right atrial pressure and thus bulging of neck veins. [pathwaymedicine.org]

  A prominent A wave frequently is found in the central venous pressure trace. [tele.med.ru]

• Right Atrial Hypertrophy

  Investigations ECG: findings are usually nonspecific; they may show right atrial hypertrophy (tall peaked 'p' waves), incomplete right bundle-branch block, Q waves in lead V1, and atrial fibrillation. [patient.info]

  atrial hypertrophy. [18] Patients with TS experience frequent arrhythmias, particularly atrial flutter and/or atrial fibrillation due to the enlargement of the right atrium. [wikidoc.org]

The treatment is usually by surgery (tricuspid valve replacement) or percutaneous balloon valvuloplasty. [en.wikipedia.org]

Diuretics and aldosterone antagonists Rarely valve repair or replacement Evidence to guide treatment of tricuspid stenosis is scarce. [msdmanuals.com]

We believe that interventional treatment of prosthetic valvular stenosis in the setting of endocarditis is a reasonable therapeutic choice when open surgical repair is associated with prohibitively high mortality. [ncbi.nlm.nih.gov]

Prognosis Prognosis is generally good but dependent on the prognosis of the underlying disease, associated other heart abnormalities and associated arrhythmias. Tricuspid regurgitation [ 1 ] The incidence of TR is less than 1%. [patient.info]

Prognosis Mild tricuspid valve stenosis is not usually considered cause for surgery. [medical-dictionary.thefreedictionary.com]

Prognosis Mortality/Morbidity The mortality associated with tricuspid stenosis depends on the precipitating cause. The general mortality rate is approximately 5%. [emedicine.com]

In over 90% of stenotic tricuspid valves, the etiology is rheumatic disease. In isolated tricuspid stenosis, the etiology is either carcinoid or congenital. [ncbi.nlm.nih.gov]

Certain conditions have both an underlying etiology and multiple body system manifestations due to the underlying etiology. [icd10coded.com]

Other cardiac anomalies are usually present. [1] Epidemiology United States data Tricuspid stenosis is rare, occurring in less than 1% of the population. [emedicine.com]

The epidemiology of rheumatoid arthritis in Ontario, Canada. Arthritis Rheumatol 2014;66:786–793. [jkma.org]

Pathophysiology Tricuspid stenosis results from alterations in the structure of the tricuspid valve that precipitate inadequate excursion of the valve leaflets. [emedicine.com]

This occurs in a similar manner to rheumatic mitral stenosis (see individual article for detailed discussion of this pathophysiology). 1-3 The characteristic hemodynamic feature of tricuspid stenosis is an increased diastolic pressure gradient between [radiopaedia.org]

[…] rheumatic fever - Prophylaxis to prevent endocarditis - rarely does the TV stenosis become so severe that these choices are required. - surgical or Balloon commissurotomy - Valve repair or replacement 2D- findings that are noted at the valve itself: [quizlet.com]

Optimal Dental Hygiene – It is essential to take proper care of the gums and teeth as a way to prevent infections. This requires routine dental visits. [rosenfeldinjurylawyers.com]

Tricuspid valve stenosis can be prevented with the adequate treatment of strep ( Streptococcus ) throat infections. [nm.org]

It functions is to prevent blood from flowing back into the right atrium. Tricuspid valve stenosis occurs when the valves leaflets are too stiff and do not open wide enough, restricting blood flow. [rahmanicardiology.com]

Find more information about Bacterial Endocarditis prevention. [my.clevelandclinic.org]

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9. Hatle L. Noninvasive assessment of valve lesions with Doppler ultra-
   sound. Herz 1984;9:213-221.