Case history
Case history
An otherwise healthy 35-year-old man presents with complaints of fatigue, lower extremity swelling, fluttering neck sensation, and a sense of abdominal fullness. Symptoms began to occur over the last few months and have been slowly progressive. The patient, who is an avid cyclist, reports increasing dyspnoea on exertion and the inability to exercise to his usual capacity. The patient's medical history is notable for an intermittent murmur, which was typically described as "innocent" when heard at routine childhood and adult examinations. He underwent tonsillectomy and adenoidectomy at age 7 years for recurrent pharyngitis. There is no family history of early coronary artery disease, cardiomyopathy, or sudden death. He does not smoke and rarely drinks alcohol.
Other presentations
Tricuspid stenosis (TS) can occur as a result of bacterial endocarditis, especially among patients with endocardial pacemaker leads, artificial tricuspid valves, or in intravenous drug abusers.[1][2] Under these conditions, the typical presenting symptoms may also include fever and other signs of infective endocarditis.
Congenital TS typically presents during infancy or very early childhood, as opposed to adulthood. It is often associated with other structural heart defects and often presents with cyanosis when an atrial level shunt is also present.
Carcinoid heart disease can cause TS and should be considered in any patient with typical carcinoid features, including facial flushing, intractable secretory diarrhoea, and bronchoconstriction.
TS caused by rheumatic heart disease can present with atrial fibrillation in 40% to 70% of patients.[3][4][5]
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