Tricuspid Valve Endocarditis on POCUS This is the bedside Echo of a critically ill young lady who presented to the ER in shock Those bright, whip-like structures emanating off the tricuspid valve are infective vegetations. They look similar to blood clots-in-transit except that instead of free floating you can see that they are tethered down. The Right Ventricle (RV) should normally be about half the size of the Left Ventricle (LV). But here the RV is more than double the size of this underfilled LV! Why would a patient with endocarditis also have right heart strain? When you see right-sided endocarditis with right heart strain you should think: tricuspid regurgitation & septic pulmonary emboli. Remember that left-sided vegetations embolize to the systemic circulation, and right-sided vegetations embolize to the lungs. The patient was resuscitated and stabilized. Blood cultures were drawn and broad-spectrum antibiotics were started. CT chest confirmed multiple septic emboli and CT Surgery was consulted for the severely regurgitant, infected tricuspid valve. Sam Ghali, M.D. @ https://twitter.com/EM_RESUS #Tricuspid #Valve #Endocarditis #POCUS #Clinical #Echocardiogram #Ultrasound #Vegetation
