Carvallo's sign

Carvallo's sign is a clinical finding associated with tricuspid regurgitation, a condition characterized by the backflow of blood from the right ventricle to the right atrium of the heart. This sign is named after the physician who first described it. Carvallo's sign is observed as an increase in the intensity of the tricuspid regurgitation murmur during inspiration. This phenomenon occurs due to the increased venous return to the right side of the heart during inhalation, which exacerbates the regurgitation.

Pathophysiology

The heart is divided into four chambers: the right and left atria, and the right and left ventricles. The tricuspid valve, located between the right atrium and right ventricle, ensures unidirectional blood flow from the atrium to the ventricle. In tricuspid regurgitation, the tricuspid valve fails to close properly during ventricular contraction, allowing blood to flow backward into the right atrium. During inspiration, the negative intrathoracic pressure increases venous return to the right side of the heart, thereby increasing the volume of regurgitation through the incompetent tricuspid valve, which in turn intensifies the murmur—a hallmark of Carvallo's sign.

Clinical Significance

Carvallo's sign is an important diagnostic tool in the assessment of tricuspid regurgitation. Its presence can help differentiate tricuspid regurgitation from other cardiac conditions that may present with similar symptoms but do not exhibit an inspiratory increase in murmur intensity. Understanding and recognizing this sign is crucial for healthcare professionals in the accurate diagnosis and management of patients with right-sided heart conditions.

Diagnosis

The diagnosis of tricuspid regurgitation and the identification of Carvallo's sign are primarily based on physical examination and confirmed through echocardiography. During the physical examination, the healthcare provider listens for heart murmurs with a stethoscope, noting any changes in their intensity with respiration. Echocardiography, particularly Doppler echocardiography, is then used to visualize the backflow of blood through the tricuspid valve, assess the severity of regurgitation, and evaluate the heart's structure and function.

Treatment

The treatment of tricuspid regurgitation depends on its severity and the underlying cause. Mild cases may not require immediate treatment but should be monitored for any signs of progression. In more severe cases, treatment options include medication to manage symptoms and, in some instances, surgical intervention to repair or replace the tricuspid valve. The management of tricuspid regurgitation aims to reduce symptoms, prevent complications, and improve the patient's quality of life.

See Also

• Heart murmur
• Echocardiography
• Right heart failure