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. Endocarditis from IV drug abuse: needle marks
6. 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