Tricuspid regurgitation

Question 1

Define:

Answer 1

Backflow of blood from the right ventricle into the right atrium due to valve insufficiency.

Question 2

Aetiology/risk factors:

Answer 2

Infective endocarditis (IV drug use)

Rheumatic heart disease

Pulmonary hypertension leading to right ventricular dilation

weakened papillary muscles due to MI leading to valve prolapse

Congenital - Ebstein’s anomaly (tricuspid cleft lower into the ventricle)

Drugs - ergot derived dopamine agonists

trauma

cirrhosis

iatrogenic

Question 3

Epidemiology:

Answer 3

depends on the cause

most common cause is infective endocarditis

Question 4

Symptoms:

Answer 4

fatigue

jaundice

leg swelling

oedema

headaches

palpitations

nausea

anorexia

breathlessness

epigastric pain which is worse when exercising

ascites

Question 5

signs:

Answer 5

parasternal heave

raised JVP which can be oscillated at the ear lobe

PANSYSTOLIC MURMUR heard louder on inspiration (carvallo sign)

Signs of pleural effusion (stoney dull percussion)

pulmonary hypertension signs

pitting oedema

abdo signs - ascites, palpable liver, jaundice

irregularly irregular pulse if in AF

Question 6

Investigations:

Answer 6

Bloods - LFT’s, blood culture, FBC and cardiac enzymes

ECG - p pulmonale (R atrial hypertrophy)

CXR - enlarged right sided cardiac shadow

Echo - doppler shows extent of the damage

right heart catheterisation - rarely done but can check pulmonary artery pressure