Tricuspid Regurgitation

Question 1

Define Tricuspid Regurgitation

Answer 1

Backflow of blood through the tricuspid valve

Question 2

Aetiology of Tricuspid Regurgitation

Answer 2

Primary (abnormal valve pathology):
Congenital - Cleft valve, AV Cana defect, Ebstein’s anomaly, Marfan’s
Acquired: Rheumatic valvulitis, infective endocarditis, Carcinoid heart disease, RA, Valve prolapse, trauma

Secondary (functional, normal valve morphology):
Left sided cardiac pathology (advanced mitral, aortic and LV disorders)
Pulmonary HTN -> RV dilation (e.g Cor Pulmonale)

Question 3

Risk factors for Tricuspid Regurgitation

Answer 3

Left heart failure
Dilate Tricuspid annulus
Rheumatic heart disease
Permanent pacemaker
Endocarditis 
Carcinoid syndrome

Question 4

Symptoms of Tricuspid Regurgitation

Answer 4

Fatigue
Headaches
Nausea
Anorexia 
Breathlessness
Palpitations 
Epigastric pain (worse on exercise)
Jaundice
Lower limb swelling

Question 5

Signs of Tricuspid Regurgitation on examination

Answer 5

AF -> irregularly irregular pulse 
Raised JVP 
Giant V waves (oscillates earlobe) 
Giant A wave if patient in sinus rhythm 
Parasternal heave 
Pan-systolic murmur heard best at the lower left eternal edge and on inspiration (Carvallo sign)
Loud P2 component of S2

May have sings of pleural effusion: stony dull percussion, reduced expansion and breath sounds
Hepatomegaly, ascites, pitting oedema

Question 6

Investigations for Tricuspid Regurgitation

Answer 6

Echo: Regurgitation + severity (may detect tricuspid abnormality e.g. prolapse)

ECG: Tall P waves (RAH) if in sinus rhythm, may show atrial flutter/fibrillation

FBC: anaemia or thrombocytopenia (Renal + liver involvement). May show leukocytosis depending on cause
U+Es normal
LFTs normal or abnormal

CXR: Right enlargement, cardiomegaly, pleural effusion

Right heart catheterisation