The most common presenting symptoms of right-sided valvular disease are dyspnea and orthopnea. Because of the organisms involved, patients presenting with tricuspid incompetence in association with endocarditis are acutely ill with sepsis. As the disease progresses, signs of right-sided heart failure are evident: jugular venous distention with a prominent a wave, peripheral edema, hepatomegaly, splenomegaly, and ascites.
In tricuspid incompetence, the murmur is soft blowing, holosystolic, and best heard along the lower left sternal border. In tricuspid stenosis, the rumbling crescendo-decrescendo diastolic murmur occurs just prior to S-, This murmur is best heard along the lower left sternal border.
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