Diastolic Murmurs

Moderate Tricuspid Stenosis Lesson

patient thorax when auscultating by stethoscope

The patient was supine during auscultation.

Description

This lesson presents moderate tricuspid stenosis. The first heart sound has increased intensity due to moderate thickening of the tricuspid valve leaflets. The second heart sound is normal and unsplit. Systole is silent.

This murmur includes a tricuspid opening snap which is followed by a diamond-shaped low-frequency murmur. There is a second murmur in late diastole due to the right atrium contraction. For this condition, the murmur intensity and tricuspid opening snap increase with inspiration.

Auscultate with the bell of the stethoscope.

In the cardiac animation, observe the turbulent blood flow from the right atrium into the right ventricle. Also observe the moderately thickened tricuspid valve leaflets and the moderately enlarged right atrium. The excursion of the tricuspid valve leaflets is moderately decreased. Moderate tricuspid stenosis is most commonly due to rheumatic heart disease.

Phonocardiogram

Anatomy

Moderate Tricuspid Stenosis

In the cardiac animation take note of the turbulent blood flow from the right atrium into the right ventricle. Observe the moderately thickened tricuspid valve leaflets and the moderately enlarged right atrium. The excursion of the tricuspid valve leaflets is moderately decreased. For this condition the murmur intensity and tricuspid opening snap increase with inspiration.

Authors and Sources

Authors and Reviewers

Heart sounds by Dr. Jonathan Keroes, MD and David Lieberman, Developer, Virtual Cardiac Patient.
Lung sounds by Diane Wrigley, PA
Respiratory cases: William French
David Lieberman, Audio Engineering
Heart sounds mentorship by >W. Proctor Harvey, MD
Special thanks for the medical mentorship of Dr. Raymond Murphy
Reviewed by Dr. Barbara Erickson, PhD, RN, CCRN.
Last Update: 11/10/2021

Sources

Heart and Lung Sounds Reference Library Diane S. Wrigley
Publisher: PESI
Impact Patient Care: Key Physical Assessment Strategies and the Underlying Pathophysiology
Diane S Wrigley & Rosale Lobo
Practical Clinical Skills: Lung Sounds
PESI Faculty - Diane S Wrigley
Case Profiles in Respiratory Care 3rd Ed, 2019
William A.French
Published by Delmar Cengage
Essential Lung Sounds by William A. French
Published by Cengage Learning, 2011
Understanding Lung Sounds Steven Lehrer, MD
Clinical Heart Disease W Proctor Harvey, MD
Clinical Heart Disease
Laennec Publishing; 1st edition (January 1, 2009)
Heart and Lung Sounds Reference Guide
PracticalClinicalSkills.com