From the Guidelines
The Carvallo sign is a clinical finding used to diagnose tricuspid regurgitation, characterized by an increase in the intensity of a systolic murmur during inspiration. This sign is a valuable tool in diagnosing tricuspid regurgitation, as it can be elicited through a simple bedside examination. The physiological basis of the Carvallo sign involves increased venous return during inspiration, which increases right ventricular preload and subsequently worsens any existing tricuspid regurgitation, as noted in the acc/aha 2006 guidelines for the management of patients with valvular heart disease 1.
Some key points to consider when assessing the Carvallo sign include:
- The murmur associated with tricuspid regurgitation is typically holosystolic or less than holosystolic, depending on the severity of hemodynamic derangement, and may increase on inspiration 1.
- The clinical features of tricuspid regurgitation also include abnormal systolic c and v waves in the jugular venous pulse, a lower left parasternal systolic murmur, and systolic hepatic pulsation 1.
- Echocardiography is a valuable diagnostic tool in assessing tricuspid valve structure and motion, measuring annular size, and identifying other cardiac abnormalities that might influence tricuspid valve function, but clinical correlation and judgment must accompany the echocardiographic results 1.
To elicit the Carvallo sign, have the patient breathe normally while auscultating the lower left sternal border, then ask them to take a deep breath and note if the murmur becomes louder. This respiratory variation helps differentiate tricuspid valve problems from other cardiac murmurs. The Carvallo sign is particularly useful in clinical settings where advanced imaging may not be immediately available, allowing for bedside assessment of potential right-sided heart valve disease.
From the Research
Definition of Carvallo Sign
The Carvallo sign, also known as the Cardiac C sign, is not directly mentioned in the provided studies.
Related Information
However, the studies discuss various aspects of aortic regurgitation and aortic valve disease, including diagnosis, treatment, and management 2, 3, 4.
Diagnosis and Treatment
Echocardiography is a key diagnostic tool for assessing aortic valve morphology and flow, as well as aortic root and ascending aorta dimensions 3, 4.
- The use of three-dimensional (3D) echocardiography is useful in evaluating the etiology and severity of aortic regurgitation 3.
- Medical management of chronic aortic regurgitation aims to control hypertension and delay left ventricular dysfunction, with angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and potentially calcium-channel blockers recommended for treatment 2.
- Surgical or percutaneous therapy is indicated when symptoms develop or in patients with left ventricular dysfunction or dilation 3.
Aortic Root Disease
Aortic root disease, including aortic root dilation, anomalous coronary artery, bicuspid aortic valve, and Marfan's syndrome, is also discussed in the context of athletes 5.
- Echocardiography, computed tomography (CT), and cardiac magnetic resonance imaging (MRI) are used for diagnosis and surgical planning 5.
- Medical management has utilized beta-blockers, with more recent use of angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor blockers (ARBs), and statins 5.
Since there is no direct information on the Carvallo sign in the provided studies, it is not possible to provide a detailed explanation of this sign.