Question

Breathing difficulty with generalized weakness. On auscultation a mid diastolic murmur with prominent wave is seen in:

• A. TS (Tricuspid Stenosis)
• B. MS (Mitral Stenosis)
• C. MR (Mitral Regurgitation)
• D. TR (Tricuspid Regurgitation)

Hint:

A prominent 'a' wave in the JVP combined with a mid-diastolic murmur indicates obstruction at the right AV valve.

Answer 1

The Correct Option is A

Step 1: Analyze the murmur character.
Mid-diastolic murmur = obstruction to flow across an AV valve during ventricular filling (diastole). The two valves that can produce a mid-diastolic murmur are the mitral valve (MS) and the tricuspid valve (TS).

Step 2: Identify the prominent wave clue.
In tricuspid stenosis, right atrial pressure is elevated and the JVP shows a prominent 'a' wave (due to forceful right atrial contraction against a stenosed tricuspid valve). This is a hallmark of TS.

Step 3: Differentiate TS from MS.

• Mitral stenosis (MS): mid-diastolic murmur at apex, opening snap, loud S1; associated with left atrial enlargement.
• Tricuspid stenosis (TS): mid-diastolic murmur at left lower sternal border, increases on inspiration (Carvallo's sign), prominent 'a' wave in JVP, hepatomegaly, right heart failure features.

The clinical picture of generalized weakness + breathing difficulty + mid-diastolic murmur + prominent wave (a-wave in JVP) is consistent with Tricuspid Stenosis.

Almost all TS cases result from rheumatic fever. Symptoms include fatigue, cold peripheries, and right upper quadrant discomfort from hepatomegaly.