Last reviewed:September 2019
Last updated:March  2019

Summary

Definition

History and exam

Key diagnostic factors

  • fatigue and effort intolerance
  • dyspnea
  • palpitations
  • jugular venous abnormality
  • irregular heart rhythm
  • parasternal systolic murmur
  • increased systolic murmur on inspiration (Carvallo sign)
  • peripheral edema

Other diagnostic factors

  • abdominal distension
  • early satiety, dyspepsia, or indigestion
  • liver and systemic venous pulsation

Risk factors

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

Diagnostic investigations

1st investigations to order

  • transthoracic or transesophageal echocardiogram
  • ECG
  • LFTs
  • serum BUN and creatinine
  • CBC
  • CXR
Full details

Investigations to consider

  • operative transesophageal echocardiogram
  • postoperative transthoracic echocardiogram
  • cardiac catheterization
  • cardiac MRI (preferred technique for evaluation of right ventricular size and function)
Full details

Treatment algorithm

Contributors

Professor of Surgery

Division of Cardiac Surgery

Department of Surgery

Brody School of Medicine

East Carolina University

Greenville

NC

Disclosures

SAA declares that he has no competing interests.

Assistant Professor

Department of Cardiac Surgery

University of Michigan

Ann Arbor

MI

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, previous contributors to this topic.

Peer reviewersVIEW 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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