tricuspid regurg

Question 1

causes

Answer 1

The most frequent cause of tricuspid incompetence is when it occurs secondary to right ventricular failure.

Question 2

s/s

Answer 2

Usually presents secondary to the symptoms of the primary problem e.g. congestive cardiac failure with the tricuspid regurgitation occurring as a consequence of the heart failure.

Features may include:

• fatigue secondary to decreased cardiac output.
• features of a raised right atrial pressure e.g. ascites and dependent oedema.
• atrial fibrillation may occur,
• jugular venous pressure - high large systolic wave seen in the neck. The ‘y’ descent is often sharp.
• hyperkinetic right ventricle -> marked pulsation at the left sternal edge.
• on auscultation - pansystolic murmur heard at the lower end of the sternum. Note that if there is right ventricular dilatation then the murmur may be heard at apex and so be difficult to distinguish from mitral regurgitation. The murmur is louder on inspiration.
• pulsatile hepatomegaly.

Question 3

ix

Answer 3

• ECG - often atrial fibrillation and right ventricular hypertrophy or right bundle branch block.
• chest x-ray - cardiomegaly (enlarged right atrium, right ventricle).
• echocardiography - right atrial and right ventricular enlargement with abnormal tricuspid cusps. Doppler scanning reveals regurgitation.
• cardiac catheterization and angiography - thickened cusps, tricuspid regurgitation.

Question 4

mx

Answer 4

Medical:

• treatment of atrial fibrillation and any heart failure

Surgical:

• annuloplasty
• replacement

Question 5

prog

Answer 5

The prognosis is determined by any associated left heart disease or pulmonary hypertension.