Tricuspid Regurgitation

Question 1

Symptoms

Answer 1

1. Asymptomatic frequently
2. Ankle swelling and breathlessness (although may reflect underlying condition causing pulmonary HTN)
3. ‘Pulsing’ in neck

Question 2

Signs

Answer 2

• swelling pulsation of the neck - the CV wave - is characteristic. If high JVP seen without other signs right heart failure then TR until proven otherwise
• parasternal heave suggests severe TR
• pan-systolic murmur lower left sternly edge louder on inspiration
• pulsation hepatomegaly

Question 3

Aetiology

Answer 3

1. Pulmonary HTN (most cases)
2. Endocarditis (look for signs of IVDU)
3. Ebsteins anomaly (apical displacement of TV valve (particularly septal leaflet) causing at least moderate regurgitation)
4. Rheumatic heart disease rare as right-sides calves rarely affected
5. Carcinoid syndrome

Question 4

Management

Answer 4

1. Medical with diuretics and treating any underlying cause of pulmonary HTN is mainstay
2. can consider surgery if oedema is uncontrollable or low cardiac output but results generally poor. Therefore very much last resort

Question 5

How would you differentiate from MR?

Answer 5

1. CV waves
2. Murmur louder on inspiration (as long as lungs don’t shift in front of steth)
3. No sign of left heart failure

Question 6

What is the CV wave in TR?

Answer 6

C wave normally represents rise in JVP as TV closes during systole. V-wave normally represents TV valves opening in early diastole. During TR there is a wave throughout the CV section (RV systole)