Tricuspid Regurgitation

Question 1

What is the pathology of tricuspid regurgitation.

Answer 1

Usually functional.

Due to dilatation of the tricuspid annulus following right ventricular dilatation.

Question 2

What are the causes of tricuspid regurgitation. (8)

Answer 2

Functional (RV dilatation). 
Rheumatic fever.
Tricuspid valve endocarditis. 
Carcinoid syndrome. 
Trauma. 
Congenital (Ebstein's anomaly, ASD). 
Drugs (ergot derives dopamine agonists). 
Endomyocardial fibrosis.

Question 3

What are some functional causes of tricuspid regurgitation. (3)

Answer 3

RV dilatation due to pulmonary hypertension (from LV failure).
Congestive cardiac failure.
Cardiomyopathy.

Question 4

What are the symptoms of tricuspid regurgitation due to.

Answer 4

The clinical features are due to venous congestion and reduced cardiac output.

Question 5

What are the physical signs of tricuspid regurgitation. (9)

Answer 5

Raised JVP with prominent v waves. 
Pansystolic murmur heard best at the left lower sternal edge in inspiration. 
Pulsatile hepatomegaly. 
Jaundice. 
Ascites. 
RV heave.
Peripheral oedema. 
Ascites.
Dyspnoea.

Question 6

What are the symptoms of tricuspid regurgitation. (6)

Answer 6

Fatigue. 
Hepatic pain on exertion. 
Ascites. 
Oedema. 
Dyspnoea and orthopnoea if the cause is LV dysfunction.