Tricuspid Regurgitation

Question 1

What are the causes of tricuspid regurgitation?
(M: TR ABCDEF)

Answer 1

1. Tricuspid valve prolapse
2. Rheumatic heart disease
3. AMI / IHD with papillary muscle infarct
4. Big heart (cardiomegaly) from pulmonary hypertension or cardiomyopathy, MR
5. Congenital - Ebstein anomaly
6. Degenerative (carcinoid syndrome)
7. Endocarditis - especially in IV drug abuse
8. Functional TR (cardiomegaly)

Question 2

What are the clinical signs of tricuspid regurgitation?

Answer 2

1. Raised JVP
2. Thrill over left sternal edge
3. Pulsatile liver, ascites and peripheral oedema
4. Evidence of infective endocarditis
5. Pulmonary hypertension (causing tricuspid regurgitation)
6. Third heard sound
7. Pansystolic murmur

Question 3

How would you investigate a patient with tricuspid regurgitation?

Answer 3

ECG: right ventricular hypertrophy
CXR: double right heart border (large left atrium)
Echo: TR jet, right ventricular dilatation

Question 4

How would you manage a patient with tricuspid regurgitation?

Answer 4

Medical management: diuretics, beta blockers, ACE inhibitors

Surgical management if medical treatment unsuccessful

Question 5

What are the complications of TR?

Answer 5

1. Right heart hypertrophy and failure
2. Infective endocarditis

Question 6

What is carcinoid syndrome?

Answer 6

Carcinoid tumour from GI tract (95%)

Malignant neuroendocrine cells secrete vasoactive substances (serotonin, bradykinin, tryptophan)
-> Damages endothelium of right heart leading to fibrosis and thickening of heart valve and myocardium
-> Regurgitation / stenosis / heart failure
-> Most commonly affecting tricuspid valve