Tricuspid Stenosis - Moderate | Lessons with Audio and Video | #99

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.

Auscultation Sounds

Position

The patient's position should be supine.

Listening Tips

S1:Increased intensity
Diastole:Opening snap then diamond shaped, low-pitch murmur

Waveform (Phonocardiogram)

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

EKG heart rhythm modules: Thomas O'Brien.
EKG monitor simulation developer: Steve Collmann
12 Lead Course: Dr. Michael Mazzini, MD.
Spanish language EKG: Breena R. Taira, MD, MPH
Medical review: Dr. Jonathan Keroes, MD
Heart sounds and mentorship: W. Proctor Harvey, MD
Medical review: Dr. Pedro Azevedo, MD, Cardiology
Last Update: 1/8/2023

Sources

Electrocardiography for Healthcare Professionals, 5th Edition Kathryn Booth and Thomas O'Brien
ISBN10: 1260064778, ISBN13: 9781260064773
McGraw Hill, 2019
Rapid Interpretation of EKG's, Sixth Edition
Dale Dublin
Cover Publishing Company
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
Clinical Heart Disease W Proctor Harvey, MD
Clinical Heart Disease
Laennec Publishing; 1st edition (January 1, 2009)
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

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Tricuspid Stenosis - Moderate | Lessons with Audio and Video | #99