Here’s the **stylishly formatted extracted text** from both pages you uploaded — beautifully structured for readability and notes use 👇 --- ## 💙 **TRICUSPID STENOSIS** ### 🫀 **Overview** * **Tricuspid stenosis (TS)** often **coexists with mitral stenosis (MS)**. * In the illustrated diagram, **both MS and TS** are shown. * ↓ **Blood flow** entering the **left ventricle (LV)** * → **Effort intolerance** (fatigue, dyspnea) ### ⚙️ **Pathophysiology** * **↑ Left atrial (LA) pressure** → Pulmonary edema → Dyspnea on exertion * **Long-standing pulmonary edema** leads to: * Pulmonary artery hypertension (**PAH**) * Right ventricular hypertrophy (**RVH**) * ↑ Diastolic pressure in the **RV** ➡️ TS acts like a **barrier**, preventing backward pressure transmission due to its narrow orifice — sparing the RV. --- ### 💢 **Clinical Features** * **Dyspnea on exertion** * **Orthopnea** (due to pulmonary congestion) * **Pulmonary artery hypertension (PAH)** * **Right-sided congestive heart failure** after **percutaneous mitral balloon valvotomy**: * Hepatomegaly * Persistent abdominal fullness * Right upper quadrant pain * Ascites * Pedal edema > ⚠️ *If untreated, may progress to **cardiac cirrhosis.*** --- ### 🩺 **On Examination** * **Large ‘a’ waves** → RA working against high pressure * **Blunted ‘y’ descent** → Reduced blood flow through the narrowed tricuspid valve * **Presystolic pulsations** of the liver * **Mid-diastolic murmur**, louder on inspiration * Best heard at **left lower sternal border** --- ## 🔬 **Investigations (Work-up)** ### 📉 **ECG** * **Large P wave (P-pulmonale)** → Peaked P wave * Limb leads: > 2.5 mm * Chest leads: > 1.5 mm * **Right axis deviation** ### 🩻 **ECHO** * **Thickened tricuspid valve** * *Severe if orifice area < 1 cm²* * *Mitral stenosis severe if < 1.5 cm²* * **Prolonged transit time:** > 190 msec ### 🫁 **Chest X-Ray** * Right atrial enlargement * Prominent superior vena cava * Enlarged shadow of azygos vein --- ## 💊 **Treatment** * 🧂 **Salt-restricted diet** * 💧 **Diuretics** * 🔧 **Valve repair** — *Main treatment* * ⚙️ **Prosthetic valve replacement** --- Would you like me to turn this into a **visually designed HTML page** (stylish UI with headings, icons, and color sections for learning/printing)?