№ 7Cardiology15 min read
Acquired valvulopathy: tricuspidal and pulmonary valve diseases
1. Big picture
Right-sided valve diseases are less common than left-sided valve diseases, but they are clinically important because they usually present as right-sided heart failure.
The four key lesions are:
| Valve disease | Core problem | Typical clinical pattern |
|---|---|---|
| Tricuspid regurgitation (TR) | Tricuspid valve does not close → systolic backflow RV → RA | Raised JVP, pulsatile liver, edema, holosystolic murmur ↑ with inspiration |
| Tricuspid stenosis (TS) | Tricuspid valve does not open → RA → RV obstruction | Giant a waves, systemic venous congestion, diastolic murmur ↑ with inspiration |
| Pulmonary stenosis (PS) | RV outflow obstruction | Systolic ejection murmur at left upper sternal border, ejection click, RV hypertrophy |
| Pulmonary regurgitation (PR) | Pulmonary valve does not close → diastolic backflow PA → RV | Early diastolic murmur; often due to pulmonary hypertension or post-intervention |
Core exam rule: Right-sided murmurs become louder with inspiration because inspiration increases venous return to the right heart. This is called Carvallo’s sign, especially important for tricuspid regurgitation.
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