💡 Overview: Right-sided valve disease is less common than left-sided disease. Think of: 👉 IV drug use → tricuspid endocarditis 👉 Carcinoid syndrome → tricuspid & pulmonary valve fibrosis 👉 Congenital heart disease (esp. repaired tetralogy of Fallot) 👉 Secondary pulmonary hypertension → functional tricuspid/pulmonary regurgitation.

🫀 Tricuspid Regurgitation (TR)

Causes: Functional (pulmonary hypertension, RV dilatation), primary (endocarditis in IVDU, rheumatic disease, congenital Ebstein anomaly).
Symptoms: Fatigue, ascites, hepatomegaly, peripheral oedema, abdominal discomfort.
Signs: Pansystolic murmur at left lower sternal border ↑ with inspiration (Carvallo’s sign), giant v-waves in JVP, pulsatile liver.
Treatment: Diuretics for symptoms; surgical repair/replacement if severe or causing RV dysfunction.

🫀 Tricuspid Stenosis (TS)

Causes: Rheumatic heart disease (rare in UK), carcinoid, congenital, post-valve repair.
Symptoms: Fatigue, abdominal bloating, ascites, right heart failure, AF from right atrial dilatation.
Signs: Mid-diastolic murmur at LLSB (↑ with inspiration), raised JVP, hepatomegaly, oedema.
Treatment: Diuretics for mild; surgery or percutaneous intervention in severe symptomatic disease.

🫁 Pulmonary Stenosis (PS)

Causes: Usually congenital (e.g., Noonan syndrome), rarely carcinoid, rheumatic.
Symptoms: Exertional dyspnoea, fatigue, syncope, cyanosis in severe cases.
Signs: Ejection systolic murmur LUSB, RV heave, wide/split S2, possible cyanosis.
Treatment: Balloon valvuloplasty for significant stenosis; surgery if unsuitable.

🫁 Pulmonary Regurgitation (PR)

Causes: Secondary to pulmonary hypertension (most common), prior cardiac surgery (e.g., TOF repair), carcinoid, endocarditis.
Symptoms: Often asymptomatic until RV dilates; dyspnoea, fatigue, RHF symptoms.
Signs: Early diastolic decrescendo murmur at LUSB, wide split S2, RV heave, RHF signs.
Treatment: Treat underlying PH; surgical repair/replacement if severe with RV dysfunction.

📊 Pulmonary Valve Disease – Comparison

Condition	Presentation	Key Signs	Investigations	Management
🫁 Pulmonary Stenosis	Dyspnoea, fatigue, syncope, RHF	Systolic ejection murmur LUSB, RV heave, wide S2	Echo (diagnostic), ECG (RVH), CXR	Balloon valvuloplasty; surgery if severe
🫁 Pulmonary Regurgitation	Dyspnoea, fatigue, RHF late	Early diastolic murmur, wide S2, RV heave	Echo, MRI for RV function	Treat PH, valve replacement if severe

📊 Tricuspid Valve Disease – Comparison

Condition	Presentation	Key Signs	Investigations	Management
🫀 Tricuspid Stenosis	Fatigue, ascites, oedema, AF	Mid-diastolic murmur LLSB, ↑JVP, hepatomegaly	Echo, ECG, CXR, cath if unclear	Diuretics; surgery if severe
🫀 Tricuspid Regurgitation	Fatigue, abdominal swelling, oedema	Pansystolic murmur ↑ inspiration, v-waves in JVP, pulsatile liver	Echo, ECG, CXR	Diuretics; surgical repair/replacement if severe

📌 Exam Pearls

Always check for risk factors: IV drug use, carcinoid syndrome, congenital repairs.
Right-sided murmurs ↑ with inspiration (Carvallo’s sign for TR).
TR and PR often secondary to pulmonary hypertension.
Carcinoid syndrome → affects right-sided valves (serotonin inactivated in lungs).
Echo is gold standard for diagnosis; MRI helps assess RV volumes.

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Right heart valve disease