Complex Conditions

Tricuspid Regurgitation - Severe Sounds

This is an example of severe tricuspid regurgitation which is caused by degeneration of the tricuspid valve leaflets.

The first heart sound is normal. The second heart sound is unsplit.

There is a loud, rectangular, pansystolic murmur.

There is a brief, rumbling, diamond-shaped diastolic murmur.

In the anatomy tab you can see the enlarged right atrium and right ventricle.

You can see the turbulent blood flow from the right ventricle into the right atrium. This is the systolic murmur.

You can see the brief turbulent blood flow from the right atrium to the right ventricle in diastole. This is caused by too much blood in the right atrium which forces blood back into the ventricle during diastole producing the flow rumble.

To differentiate tricuspid regurgitation from mitral regurgitation, the maximum intensity of the tricuspid murmur is heard at the left lower sternal border. In addition, the murmur intensity increases with inspiration.

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The recommended auscultation position for the stethoscope is the Tricuspid position. For this sound, use stethoscope's Diaphragm.

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The recommended patient position is Supine

Phonocardiogram

This waveform plots sound amplitude on the vertical axis against time on the horizontal axis.

Heart Animation

Lessons

1	Mitral Regurgitation - Severe
2	Tricuspid Regurgitation - Severe
3	Mitral Stenosis Severe and Regurgitation Mild - Rheumatic Origin
4	Aortic Stenosis Moderate and Regurgitation Mild - Rheumatic Origin
5	Mitral Regurgitation and Aortic Regurgitation
6	Acute Pericarditis

Practice Drill

Listening Tips
A synopsis of important sound features and timing for this abnormality.
Systole: Loud, pan-systolic murmur, louder during inspiration.
Diastole: Brief, rumbling diamond shaped murmur may follow pan-systolic murmur in some cases.

CaseID	102
CourseID	28
CourseCaseOrder	2
ID	92