Tricuspid Regurgiation

Question 1

Define tricuspid regurgitation

Answer 1

Backflow of blood from RV -> RA during systole

Question 2

What are the causes/risk factors of tricuspid regurgitation?

Answer 2

• Ebstein abnormality
(malpositioned tricuspid valve)
• Right ventricular dilatation e.g.
pulmonary HTN
• Valve prolapse
• Rheumatic heart disease
• Infective endocarditis
• Carcinoid syndrome
• Cirrhosis
• Radiotherapy

Question 3

What are the symptoms of tricuspid regurgitation?

Answer 3

• Fatigue
• SOB
• Palpitations
• Nausea
• Oedema

Gut and liver congestion
• Early satiety
• Epigastric pain/indigestion (worsened by exercise)
• Jaundice

Question 4

What are the signs of tricuspid regurgitation?

Answer 4

• Irregularly irregular pulse – AF due to right atrial enlargement
• Raised JVP with giant cv waves
• Parasternal heave (RVH)
• Pansystolic murmur at left lower sternal edge in inspiration
• Loud P2
• Palpable, pulsatile liver
• Ascites
• Pitting oedema

Question 5

What investigations are carried out for tricuspid regurgitation?

Answer 5

• transthoracic or transoesophageal echocardiogram - assessment of left and right heart ejection fraction/dilation, valve morphology/function; evidence of pericardial disease, constrictive/restrictive physiology, may show regional wall motion abnormalities
• ECG - may show atrial flutter/fibrillation; presence of previous myocardial infarction
• LFTs
• serum urea and creatinine - normal or elevated
• FBC - anaemia (e.g., anaemia of chronic disease, renal failure), thrombocytopenia (e.g., due to liver failure and cirrhosis)
• CXR - may show cardiomegaly, pleural or pericardial effusion, presence of pacemaker