Tricuspid Regurgitation

Question 1

what is the definition of tricuspid regurgitation

Answer 1

backflow of blood from RV to RA in systole

Question 2

what is the aetiology of tricuspid regurg

Answer 2

congenital
functional
rheumatic heart disease
infective endocarditis
other

Question 3

what are the congenital causes of tricuspid regurg

Answer 3

ebstein anomaly-malpositioned tricuspid valve

ostium primum defect-cleft tricuspid valve

Question 4

what are the functional causes of tricuspid regurg

Answer 4

consequence of RV dilation in pulmonary HTN

valve prolapse

Question 5

whom is infective endocarditis common in

Answer 5

IV drug users

Question 6

what are the other causes of tricuspid regurg

Answer 6

carcinoid syndrome
trauma
long-standing cirrhosis
iatrogenic(radiotherapy to thorax)

Question 7

what is the epidemiology of tricuspid regurg

Answer 7

infective endocarditis is the most common cause

Question 8

what history is associated with tricuspid regurg

Answer 8

epigastric pain worse on exercise
jaundice
fatigue, SOB, palpitations, headaches, nausea, anorexia, ankle swelling

Question 9

what examination findings would be expected in tricuspid regurg

Answer 9

inspection
-pulse irregularly irregular(AF) with RA enlargement
-raised JVP (due to transmission of RV pressure to great veins, giant 'v' waves which correspond to venous fillling, giant 'a' waves which correspond to arterial filling if in sinus rhythm)
palpation
-parasternal heave
auscultation
-pansystolic murmur (lower left sternal edge, louder on inspiration, loud P2 at S2)
chest
-pleural effusion
-causes of pulmonary HTN(emphysema)
hepatomegaly
ascites
pitting oedema

Question 10

what is the carvallo sign

Answer 10

pansystolic murmur of tricupid regurg

louder on inspiration

Question 11

what investigations would be performed in suspected tricuspid regurg

Answer 11

1 bloods
-FBC, LFTs, cardiac enzymes, blood cultures
2 ECG
-tall P wave if in sinus rhythm
-indicates RA hypertrophy-de
3 CXR
-R enlargement of cardiac shadow
4 echo
-detects tricuspid valve abnormality(prolapse)
-detects RV dilation
-determines extent of regurg by doppler
5 R heart catheterisation
-considered to measure pulmonary artery pressure