Tricuspid stenosis

Last reviewed: 27 Dec 2022
Last updated: 23 Dec 2021



History and exam

Key diagnostic factors

  • history of acute rheumatic fever (ARF) during childhood
  • dyspnea
  • elevated jugular venous pressure with prominent a-wave
  • low-frequency presystolic (diastolic) murmur at lower left sternal border
More key diagnostic factors

Other diagnostic factors

  • age: 40 to 59 years
  • exercise intolerance
  • fatigue
  • jugular pulsations
  • abdominal swelling and discomfort
  • edema
  • cyanosis or hypoxemia
  • atrial fibrillation
  • hepatomegaly
  • ascites, edema, anasarca
  • age: infancy or childhood
  • episodic facial flushing, watery diarrhea, or bronchoconstriction
  • absent right ventricular lift or heave
  • opening snap
  • endocarditis stigmata (e.g., splinter hemorrhages, Osler nodes, Janeway lesions)
Other diagnostic factors

Risk factors

  • group A streptococcal (GAS) pharyngitis
  • metastatic carcinoid tumors
  • artificial tricuspid valve
  • intravenous drug use
  • pacemaker/defibrillator leads crossing tricuspid valve orifice
  • genetic predisposition and environmental factors
More risk factors

Diagnostic investigations

1st investigations to order

  • ECG
  • chest x-ray
  • 2D transthoracic echocardiogram
  • Doppler transthoracic echocardiogram
  • liver function tests
  • blood biochemistry
  • CBC
  • blood cultures
  • 24-hour urinary excretion of 5-hydroxy-indole acetic acid (5-HIAA)
More 1st investigations to order

Investigations to consider

  • cardiac catheterization
  • cardiac MRI
  • 3D transthoracic echocardiogram
More investigations to consider

Treatment algorithm



with carcinoid heart disease

with rheumatic fever sequelae

with infective endocarditis



John R. Charpie, MD, PhD
John R. Charpie


Pediatrics and Communicable Diseases

Division Director

Pediatric Cardiology

Medical Director

Pediatric Cardiothoracic ICU

University of Michigan Congenital Heart Center

Ann Arbor



JRC declares that he has no competing interests.

Jeffrey D. Zampi, MD
Jeffrey D. Zampi

Associate Professor

Pediatrics and Communicable Diseases

Director, Interventional Pediatric Cardiology

University of Michigan Congenital Heart Center

Ann Arbor



JDZ is and has been a consultant for Medtronic and Abbott.


Dr John R. Charpie and Dr Jeffrey D. Zampi would like to gratefully acknowledge Dr Martin L. Bocks, a previous contributor to this topic.


MLB declares that he has no competing interests.

Peer reviewers

Lokesh Tejwani, MD, FACC

Assistant Professor of Clinical Medicine

University of Missouri Hospitals and Clinics

Harry S. Truman VA Hospital




LT declares that he has no competing interests.

John Coltart, MD, FRCP, FACC, FESC, MRCS

Consultant Cardiologist

Cardio-thoracic Unit

Guy's and St Thomas' Hospital




JC declares that he has no competing interests.

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