Podcast Episode 94: Murmurs Made Incredibly Easy (Part 4 of 5) – Tricuspid Stenosis

Welcome to episode 94 of the Audio PANCE and PANRE PA board review podcast. Today is part four of this fabulous five-part series with Joe Gilboy PA-C, all about cardiac murmurs. In this week's episode of the Audio PANCE and PANRE podcast, we continue our discussion of cardiac murmurs with a focus on the tricuspid valve. We'll cover the ins and outs of tricuspid valve stenosis and learn how to identify it and differentiate it from other types of murmurs. If you haven't already, make sure to listen to our previous podcast episode where we covered aortic valve murmurs and mitral valve murmurs, and pulmonic valve murmurs. The Tricuspid Valve The tricuspid valve, or right atrioventricular valve, is a one-way valve that sits between the right atrium and right ventricle of the heart. It is essential for right ventricular filling and for preventing the backflow of blood from the right ventricle into the right atrium when the right ventricle contracts during systole. When functioning properly, the tricuspid valve is a passive structure that opens and closes in response to the pressure of the blood flowing through the heart. The right atrium receives deoxygenated blood from the superior and inferior vena cava. The tricuspid valve which separates the right atrium from the right ventricle opens during ventricular diastole, allowing the deoxygenated blood to flow from the right atrium into the right ventricle, and closes during ventricular systole preventing the backflow of blood from the right ventricle into the right atrium as the right ventricle contracts to pump blood into the lungs out through the pulmonary artery. Tricuspid Valve Stenosis Tricuspid stenosis is a narrowing of the tricuspid valve or one of its three leaflets. If the tricuspid valve is narrowed or stenotic, it will not open properly during diastole, increasing the volume of blood in the right atrium. When the right ventricle contracts the stiffened tricuspid valve also fails to close completely and tricuspid regurgitation develops. Nearly all cases are caused by rheumatic fever. Podcast Episode 94: Murmurs Made Incredibly Easy (Part 4 of 5) – Tricuspid Valve Stenosis Below is a transcription of this podcast episode edited for clarity. You can download and listen to past FREE episodes here, on iTunes, Spotify, Google Podcasts, Stitcher, Amazon Music, and most podcasting apps.You can listen to the latest episode and access even more resources below. Welcome everybody, this is Joe Gilboy PA-C and I work with Stephen Pasquini at Smarty PANCE. Today, we will continue this series on heart murmurs. Today's topic is tricuspid stenosis. So, sit back, listen to my voice, and try not to take notes. Don't do anything other than just listen and follow my logic. I promise you, when this is all said and done, you'll be looking at heart murmurs and more specifically, tricuspid stenosis in a vastly different light. I want you to view the tricuspid valve. Just think about it. There you are the right atria. The tricuspid valve opens during diastole and closes during systole. There's all your blood in the right ventricle, and it goes out through the pulmonary valve to get oxygenated out in the lungs. So now, I want you to think about this for a second. I have a tricuspid valve that is stenotic. It's stiff and hard to open. When are you going to have problems opening this valve? During diastole? Or during systole? You are going to have problems with this during diastole because that's when the tricuspid valve is supposed to open up. Because it's supposed to be closed during systole. So, it's a diastolic murmur, it's considered a mid-diastolic murmur. Now give this some more thought. Okay, so you're in the right atria - Is it easier or harder to push through this stenotic valve? Oh, it's a lot harder. And so, where's the blood flow going to back up to? Into the right atrium and now that right atrium,