TR Flashcards
definition of TR
backflow of blood from the right ventricle to the right atrium during systole.
aetiology of TR
congenital
- Ebstein anomaly - malpositioned tricuspid valve
- cleft valve in ostium primum defect
- ASD
- AV canal
functional
- consequence of RV dilation eg in pul hypertension induced by LV failure or PE
- valve prolapse
rheumatic heart disease - associated with other valvular disease
infective endocarditis - common in IVDU, usually staph
carcinoid syndrome
trauma
cirrhosis (long-standing)
iatrogenic eg radiotherapy to the thorax
drugs - ergot-derived dopamine agonists, fenfluramine
epidemiology of TR
The epidemiology differs with various causes.
Infective endocarditis probably most common cause.
sx of TR
- fatigue
- breathlessness
- palpitations
- headaches
- nausea
- anorexia
- epigastric/hepatic (due to hepatic congestion) pain made worse by exercise
- jaundice
- ascites
- lower limb swelling
signs of TR
irregularly irregular pulse due to AF (occur with RA enlargement)
raised JVP
- giant V waves which may oscillate to the earlobe, caused by transmission of the RV pressure to the great veins
- might be giant a wave of pt is in sinus rhythm
- prominent y descent
RV parasternal heave
Pansystolic murmur heard best at the lower left sternal edge, louder on inspiration (Carvallo sign).
Loud P2 component of second heart sound.
chest
- pleural effusion
- causes of pul hypertension eg emphysema
abdo
- Palpable liver (tender, smooth, pulsatile)
- ascites.
legs - pitting oedema
Ix for TR
blood - FBC, LFT, cardiac enzymes, blood cultures
ECG
- Tall P wave (right atrial hypertrophy) if in sinus rhythm.
- Changes indicative of other cardiac disease.
CXR - R sided enlargement of cardiac shadow
echo
- Extent of regurgitation estimated by colour flow Doppler.
- May be able to detect tricuspid valve abnormality (e.g. prolapse)
- right ventricular dilation.
R heart catheterisation - Rarely necessary, may be considered to assess pulmonary artery pressure.
