Tricuspid regurgitation Flashcards
What is the underlying pathology of tricuspid regurgitation?
Reflux of blood from the right ventricle into the right atrium during systole due to inadequate valve closure.
What is functional tricuspid regurgitation?
Tricuspid regurgitation caused by right ventricular and right atrial dilation without primary valvular disease.
What are the main causes of tricuspid regurgitation?
Functional (right heart dilation), valvular damage (endocarditis, rheumatic heart disease, carcinoid syndrome), congenital (Ebstein anomaly), and iatrogenic (pacemaker or ICD leads).
What is Ebstein anomaly and how does it relate to tricuspid regurgitation?
A congenital defect where the tricuspid valve is displaced apically into the right ventricle, causing severe regurgitation.
Why are IV drug users at risk for tricuspid regurgitation?
They are at high risk for infective endocarditis, which commonly affects the tricuspid valve.
What is carcinoid syndrome and how does it affect the tricuspid valve?
A syndrome caused by serotonin-secreting neuroendocrine tumors, leading to right-sided heart fibrosis and tricuspid regurgitation.
What are common symptoms of carcinoid syndrome?
Flushing, diarrhea, bronchospasm, and right-sided valvular heart disease.
Which cardiac devices can cause tricuspid regurgitation?
Pacemaker and ICD leads, which can mechanically damage the tricuspid valve.
What type of murmur is heard in tricuspid regurgitation?
A holosystolic murmur best heard at the left mid-sternal border, increasing with inspiration (Carvallo’s sign).
What other physical exam findings are associated with tricuspid regurgitation?
Right ventricular heave, hepatomegaly, ascites, peripheral edema, and signs of right-sided congestive heart failure.
How does tricuspid regurgitation affect the jugular venous pressure waveform?
It produces a prominent v-wave due to increased right atrial pressure during systole.
What is the best initial test for diagnosing tricuspid regurgitation?
Transthoracic echocardiography (TTE).
How does severe tricuspid regurgitation appear on echocardiography?
Right ventricular dilation, systolic reversal of flow in the hepatic veins, and color Doppler showing regurgitation.
How is functional tricuspid regurgitation managed?
Treat the underlying cause (e.g., heart failure management, pulmonary hypertension treatment).
When is surgical repair or valve replacement indicated for tricuspid regurgitation?
Severe symptomatic tricuspid regurgitation despite medical management or when undergoing left-sided valve surgery.
What are the surgical options for tricuspid regurgitation?
Tricuspid valve annuloplasty (repair) or valve replacement (bioprosthetic or mechanical).
What is the prognosis of untreated severe tricuspid regurgitation?
Progressive right heart failure, leading to hepatic congestion, ascites, and decreased survival.
