Tricuspid Stenosis

Tricuspid stenosis is a diastolic murmur similar in quality to mitral stenosis, but is best heard over the left lower sternal border, or between the left lower sternal border and the apex. It also becomes louder with inspiration (Carvallo’s sign).
Associated findings include a giant a wave in the jugular venous waveform (accentuated with inspiration), as well as a diminished y descent.

Card Tutorial

Patient 1

This is a young man with a bioprosthetic tricuspid valve related to a history of infective endocarditis secondary to intravenous drug use, who was admitted to the hospital with recurrent infective endocarditis of the tricuspid valve. Physical examination demonstrated giant a waves in the jugular venous waveform as well as a late diastolic murmur that augmented with inspiration. Echocardiography demonstrated a large vegetation on the bioprosthetic tricuspid valve with an associated mean transtricuspid valve gradient of 17 mm Hg, consistent with severe tricuspid stenosis.

Tricuspid Stenosis

Annotated