Last reviewed: November 2017
Last updated: December  2017

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • fatigue and effort intolerance
  • dyspnoea
  • palpitations
  • jugular venous abnormality
  • irregular heart rhythm
  • parasternal systolic murmur
  • increased systolic murmur on inspiration (Carvallo's sign)
  • peripheral oedema

Other diagnostic factors

  • abdominal distension
  • early satiety, dyspepsia, or indigestion
  • liver pulsation

Risk factors

  • left-sided heart failure
  • dilated tricuspid annulus
  • rheumatic heart disease
  • permanent pacemaker
  • endocarditis
  • carcinoid heart disease
  • pacemaker lead entrapment
  • ischaemic cardiomyopathy
  • constrictive pericarditis
  • congenital heart disease
  • toxins
  • rheumatoid arthritis
  • radiotherapy
  • trauma
  • Marfan's syndrome
  • tricuspid valve prolapse

Diagnostic investigations

1st investigations to order

  • transthoracic echo
  • ECG
  • LFTs
  • serum urea and creatinine
  • FBC
  • CXR
Full details

Investigations to consider

  • operative transoesophageal echo
  • postoperative transthoracic echo
  • cardiac catheterisation
  • cardiac MRI (preferred technique for evaluation of right ventricular size and function)
Full details

Treatment algorithm

Contributors

Authors VIEW ALL

Professor of Surgery

Chairman, Division of Cardiothoracic Surgery

Department of Surgery

University of Wisconsin School of Medicine and Public Health

Madison

WI

Disclosures

SAA declares that he has no competing interests.

Assistant Professor

Division of Cardiothoracic Surgery

University of Wisconsin

Madison

WI

Disclosures

PT declares that he has no competing interests.

Dr Shahab A. Akhter and Dr Paul Tang would like to gratefully acknowledge Dr Kevin L. Greason, Dr Sorin V. Pislaru, and Prof. Thoraf M. Sundt III, the previous contributors to this monograph. KLG and SVP declare that they have no competing interests. TMS is an author of a reference cited in this monograph.

Peer reviewers VIEW ALL

Assistant Professor of Medicine

Harvard Medical School

Watertown

MA

Disclosures

LAW declares that he has no competing interests.

Consultant Cardiothoracic Surgeon

Imperial College Healthcare NHS Trust

London

UK

Disclosures

PPP declares that he has no competing interests.

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