Tricuspid Regurgitation - Severe 282

Introduction to Clinical Electrophysiology and the ECG

Here we present an example of severe tricuspid regurgitation which is caused by degeneration of the tricuspid valve leaflets. The first heart sound is normal. The second heart sound is unsplit. There is a loud, rectangular, pansystolic murmur. There is a brief, rumbling, diamond-shaped diastolic murmur. In the anatomy video you can see the enlarged right atrium and right ventricle. You can see the turbulent blood flow from the right ventricle into the right atrium. This is the systolic murmur. You can see the brief turbulent blood flow from the right atrium to the right ventricle in diastole. This is caused by too much blood in the right atrium which forces blood back into the ventricle during diastole producing the flow rumble. To differentiate tricuspid regurgitation from mitral regurgitation, the maximum intensity of the tricuspid murmur is heard at the left lower sternal border. In addition, the murmur intensity increases with inspiration.

Listen

patient thorax when auscultating by stethoscope

The patient was supine during auscultation.

Visualize

Observe

Review the animation. Observe the enlarged right atrium and right ventricle. You can see the turbulent blood flow from the right ventricle into the right atrium. This is the systolic murmur. Notice the brief turbulent blood flow from the right atrium to the right ventricle in diastole. This is caused by too much blood in the right atrium which forces blood back into the ventricle during diastole producing the flow rumble. To differentiate tricuspid regurgitation from mitral regurgitation, the maximum intensity of the tricuspid murmur is heard at the left lower sternal border. In addition, the murmur intensity increases with inspiration.