PREFERRED PRACTICE PATTERN
A 65-year-old male presents to physical therapy for weakness, pulsations in the neck, and fatigue. He has a history of mild hypertension that is well controlled on lisinopril. Vitals are: Pulse: 70, Respirations: 14, Blood Pressure: 124/84, Temperature: 97.9°F, and SpO2% of 96%. On physical examination, there is mild distension of the jugular veins on the right side of the neck and a palpable right ventricular heave. On auscultation, there is a holosystolic murmur at the right mid-sternal border. With leg raising the murmur gets louder. The patient was referred to the cardiologist. ECG and chest X-ray show signs of right atrial and ventricular enlargement. Echocardiography reveals a vena contracta of 0.8 cm and a dilated tricuspid annulus.
Tricuspid valve does not close properly during systole
Causes a backflow and fluid overload in the right atrium
Fluid overload in the right atrium can lead to weakening of the right atrial wall
A Doppler signal due to the severe tricuspid regurgitation. In tricuspid regurgitation, the high-velocity flow is recorded during systole and not in diastole (Dias). Because the jet of tricuspid regurgitation is flowing away from the transducer, a negative signal is recorded. The simplified Bernoulli equation can be used to estimate the pressure difference between the right ventricle and the right atrium from the peak velocity recorded from the tricuspid regurgitation signal (3.74 m/s or 374 cm/s). (From Nicoll D, Lu CM, Pignone M, et al. Pocket Guide to Diagnostic Tests. 6th ed. www.accessmedicine.com. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.)
Signs and symptoms should be monitored
Mild-to-moderate regurgitation generally does not cause symptoms
Symptoms are often weakness and fatigue
Patients can develop bacterial endocarditis
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