Tricuspid Regurgitation

Question 1

Define tricuspid regurgitation.

Answer 1

Tricuspid regurgitation (TR) occurs when blood flows backwards through the tricuspid valve. In the vast majority of patients, this occurs during systole, but severely elevated right ventricular filling pressure can be associated with diastolic TR.

Question 2

Explain the aetiology/risk factors of tricuspid regurgitation.

Answer 2

Left-sided heart failure
Dilated tricuspid annulus
Rheumatic heart disease
Permanent pacemaker
Endocarditis
Carcinoid heart disease

Question 3

Summarise the epidemiology of tricuspid regurgitation.

Answer 3

Some degree of valvular regurgitation is a quite common accidental finding in colour Doppler imaging. In fact, two-dimensional echocardiography has demonstrated that 50% to 60% of asymptomatic young adults exhibit mild tricuspid regurgitation.

Question 4

Recognise the presenting symptoms of tricuspid regurgitation.

Answer 4

Fatigue and effort intolerance
Dyspnoea
Palpitations

Question 5

Recognise the signs of tricuspid regurgitation on physical examination.

Answer 5

Jugular venous abnormality
Irregular heart rhythm
Parasternal systolic murmur
Increased systolic murmur on inspiration (Carvallo’s sign)
Peripheral oedema

Question 6

Identify appropriate investigations for tricuspid regurgitation and interpret the results.

Answer 6

ECG
Doppler USS
Echo
LFTs
Serum urea and creatinine
FBC