This is an example of moderate tricuspid stenosis which is most commonly due to rheumatic heart disease.
The first heart sound is increased in intensity due to moderate thickening of the tricuspid valve leaflets.
The second heart sound is normal and unsplit.
Systole is silent.
There is a tricuspid opening snap followed by a diamond shaped low frequency murmur. Use the bell of the stethoscope to hear this murmur.
There is a second murmur in late diastole due to contraction of the right atrium.
In the animation you can see the turbulent blood flow from the right atrium into the right ventricle. You can see 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.
Tricuspid Stenosis - Moderate Audio
Technique
The patient's position should be supine.
Auscultation Tips
S1:Increased intensityDiastole:Opening snap then diamond shaped, low-pitch murmur
Sound Wave
Observe Cardiac Animation
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
- ECG heart rhythm modules: Thomas O'Brien.
- ECG monitor simulation developer: Steve Collmann
-
12 Lead Course: Dr. Michael Mazzini, MD.
- Spanish language ECG: Breena R. Taira, MD, MPH
- Medical review: Dr. Jonathan Keroes, MD
- Medical review: Dr. Pedro Azevedo, MD, Cardiology
- Last Update: 11/8/2021
Sources
-
Electrocardiography for Healthcare Professionals, 6th Edition
Kathryn Booth and Thomas O'Brien
ISBN10: 1265013470, ISBN13: 9781265013479
McGraw Hill, 2023 -
Rapid Interpretation of EKG's, Sixth Edition
Dale Dublin
Cover Publishing Company -
EKG Reference Guide
EKG.Academy -
12 Lead EKG for Nurses: Simple Steps to Interpret Rhythms, Arrhythmias, Blocks, Hypertrophy, Infarcts, & Cardiac Drugs
Aaron Reed
Create Space Independent Publishing -
Heart Sounds and Murmurs: A Practical Guide with Audio CD-ROM 3rd Edition
Elsevier-Health Sciences Division
Barbara A. Erickson, PhD, RN, CCRN -
The Virtual Cardiac Patient: A Multimedia Guide to Heart Sounds, Murmurs, EKG
Jonathan Keroes, David Lieberman
Publisher: Lippincott Williams & Wilkin)
ISBN-10: 0781784425; ISBN-13: 978-0781784429 - Project Semilla, UCLA Emergency Medicine, EKG Training Breena R. Taira, MD, MPH
-
ECG Reference Guide
PracticalClinicalSkills.com
Tricuspid Stenosis - Moderate | Auscultation Cheat Sheet with Sounds & Video | #99
