Rheumatic (usually associated with mitral and aortic valve disease). Carcinoid syndrome. Congenital.
Clinical manifestations of associated mitral stenosis may dominate. Little or no dyspnoea. Fatigue is common. Refractory oedema, ascites and marked hepatomegaly with presystolic pulsation. NP is raised with prominent a waves (giant a waves) and slow x descent. At lower left sternal border, a tricuspid opening snap, loud first heart sound and a mid-diastolic murmur with presystolic accentuation are heard. Tricuspid murmur increases during inspiration (De-Carvallo's sign).
Salt and fluid restriction. Diuretics. Surgical relief of tricuspid stenosis.