Tricuspid Regurgitation

Question 1

What is tricuspid regurgitation?

Answer 1

Backflow of the blood from the right ventricle to the right atrium, during systole.

Question 2

What are some common causes of TR?

Answer 2

Infective endocarditis
Rheumatic Fever
Tricuspid valve prolapse
Right ventricle dilation
Congenital e.g. Marfan's

Question 3

What is the most common cause of TR?

Answer 3

Infective endocarditis

Question 4

How would a patient with TR present?

Answer 4

• dyspnoea, palpitations
• nausea, epigastric pain that is worse on exercise
• raised JVP
• pan-systolic murmur, heard best on inspiration at lower left sternal edge
• possible S3
• signs of liver disease e.g. jaundice, ascites

Question 5

How would you investigate a patient with TR?

Answer 5

Bloods:

• FBC
• LFTs
• cardiac enzymes
• culture

ECG - tall P-waves

CXR - may show right heart enlargements

Echo + Doppler - to visualise and assess severity

Question 6

How would you manage a patient with TR?

Answer 6

Conservative Tx - treat underlying cause + diuretics

Surgery - annuloplasty, plication, valve replacement ONLY if very severe

Question 7

What does a parasternal heave indicate?

Answer 7

Increased force of contraction as a compensatory mechanism

Question 8

What is the main complication of TR?

Answer 8

Heart failure