Tricuspid Incompetence

Question 1

Tricuspid incompetence presentation

Answer 1

Examine this patient’s cardiovascular system. He has been complaining of abdominal discomfort.

Question 2

Clinical signs of Tricuspid incompetence

Answer 2

1. Raised JVP with giant CV waves
2. Thrill at the left sternal edge
3. Auscultation:
   - Pan-systolic murmur (PSM) loudest at the tricuspid area (lower left sternal edge) in inspiration.
   - Reverse split second heart sound due to rapid RV emptying.
   - Right ventricular rapid filling gives an S3
4. Pulsatile liver, ascites and peripheral oedema
5. Cause: Endocarditis from IV drug abuse: needle marks
6. Severity: Pulmonary hypertension: RV heave and loud P2
7. Other valve lesions: rheumatic mitral stenosis

Question 3

Auscultation in Tricuspid Incompetence

Answer 3

1. Pan-systolic murmur (PSM) loudest at the tricuspid area (lower left sternal edge) in inspiration.
2. Reverse split second heart sound due to rapid RV emptying.
3. Right ventricular rapid filling gives an S3

Question 4

Causes of Tricuspid incompetence

Answer 4

Congenital: Ebstein’s anomaly (atrialization of the right ventricle and TR)
Acquired:
- Acute: infective endocarditis (IV drug user)
- Chronic:
- functional (commonest),
- rheumatic and
- carcinoid syndrome

Question 5

Investigation of Tricuspid incompetence

Answer 5

1. ECG: p‐pulmonale (large, peaked) and RVH
2. CXR: double right heart border (enlarged right atrium)
3. TTE: TR jet, RV dilatation

Question 6

Management of Tricuspid incompetence

Answer 6

1. Medical: diuretics, β‐blockers, ACE inhibitors and support stockings for oedema
2. Surgical: valve repair/annuloplasty if medical treatment fails