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New murmur
  1. Dominic Hayes,
  2. Holly Morgan,
  3. Nigel Brown
  1. Cardiology, Royal Gwent Hospital, Aneurin Bevan University Health Board, Newport, UK
  1. Correspondence to Dr Dominic Hayes, Aneurin Bevan University Health Board, Newport NP18 3XQ, UK; dwhayes96{at}

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Clinical introduction

A woman in her 60s was referred for a routine echocardiogram after identification of a systolic murmur by her general practitioner. She was asymptomatic and clinical examination revealed only mild ankle oedema. Medical history included treated hypertension, a right nephrectomy and adrenalectomy 2 years previously for a benign cystic lesion and a 5 cm ovarian cyst under gynaecology surveillance. She had also recently been diagnosed with irritable bowel syndrome (IBS) by gastroenterology.

Transthoracic echocardiography demonstrated thickening of the tricuspid valve with severe regurgitation and a pulmonary artery systolic pressure of 55 mm Hg (figure 1). There was also mild to moderate mitral regurgitation and mild left ventricular dysfunction, …

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  • Contributors All authors contributed to the idea generation, manuscript production and review. DH was responsible for manuscript submission.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, conduct, reporting or dissemination plans of this research.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.