Tricuspid Regurgitation Flashcards
What is the defnition of tricuspid regurgitation?
Backflow of blood from the right ventricle to the right atrium during systole
What is the aetiology of tricuspid regurgitation?
Congenital
- Ebstein’s anomaly (malpositioned tricuspid valve)
- Cleft valve in ostium primum
Functional
- Consequence of right ventricular dilation (e.g. due to pulmonary hypertension)
- Valve prolapse
Rheumatic Heart Disease
Infective Endocarditis
Other: carcinoid syndrome, trauma, cirrhosis, iatrogenic
What is the epidemiology of tricuspid regurgitation?
Differs based on cause
Infective endocarditis is the MOST COMMON cause
What are the presenting symptoms of tricuspid regurgitation?
Fatigue
Breathlessness
Palpitations
Headaches
Nausea
Anorexia
Epigastric pain made worse by exercise
Jaundice
Lower limb swelling
What are the signs of tricuspid regurgitation upon physical examination?
Pulse - irregularly irregular if AF
Inspection
- Raised JVP with giant V waves (which may oscillate the earlobes)
- This is caused by transmission of high right ventricular pressures into the great veins
- Giant A waves may also be present
Palpation - parasternal heave
Auscultation
- Pansystolic murmur - heard best at lower left sternal edge
- Louder on inspiration (Carvallo sign)
- Loud P2 component of second heart sound
Chest Examination may show signs of:
- Pleural effusion
- Causes of pulmonary hypertension
Abdominal Examination may show:
- Palpable liver (tender, smooth and pulsatile)
- Ascites
Legs - pitting oedema
What are the appropriate investigations for tricuspid regurgitation?
Bloods
- FBC
- LFT
- Cardiac enzymes
- Blood cultures
ECG
- P pulmonale - due to right atrial hypertrophy
CXR
- Right-sided enlargement of cardiac shadow
Echocardiography
- Extent of regurgitation can be estimated using Doppler ultrasound
- May show valve prolapse and right ventricular dilation
Right Heart Catheterisation
- Rarely necessary but may be useful for assessing pulmonary artery pressure
