Tricuspid Regurgitation

Question 1

Define Tricuspid Regurgitation

Answer 1

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

Question 2

Explain the aetiology/risk factors of tricuspid regurgitation

Answer 2

• A consequence of right ventricular dilation (due to RHF due to LHF) -MOST COMMON
• Infective Endocarditis by Staph aureus (IVDU) - this is the first valve encountered by the drug after IV administration
• Permanent Pacemaker, the wire inserts into RV via tricuspid
• Congenital: Ebstein’s anomaly (malpositioned tricuspid valve, lithium exposure in utero)
• Carcinoid syndrome: Paraneoplastic syndrome causing valve thickening
• Rheumatic Heart Disease

Question 3

Recognise the presenting symptoms of tricuspid regurgitation

Answer 3

• Left heart failure symptoms (pulmonary vascular congestion) - these symptoms present earlier:
  
  • Exertional dyspnoea
  • Fatigue
• Palpitations due to AF
• Eventually, RHF symptoms (systemic venous congestion):
  
  • Peripheral pitting oedema
  • RUQ due to hepatic congestions
  • Ascites/Abdominal distention
  • Early satiety (gut congestion)

Question 4

Recognise the signs of tricuspid regurgitation on physical examination

Answer 4

• Pansystolic murmur - heard best at lower left sternal edge
  
  • Louder on inspiration (Carvallo sign) - distinguishes TR from MR
• Pulse - irregularly irregular if AF
• Inspection
  
  • Raised JVP with giant v waves (may oscillate the earlobes) during systole due to the regurgitant blood from the RV
• Parasternal heave
• Abdominal Examination may show:
  
  • Systolic hepatic pulsations, due to advanced liver disease from chronic congestion or fibrosis (cardiac cirrhosis)
  • Ascites
• Legs - pitting oedema

Question 5

Identify appropriate investigations for tricuspid regurgitation and interpret the results

Answer 5

• Transthoracic/Transoesophageal Echocardiogram ± Doppler: asses L&R Ejection fractions, valvular disease aetiology
• ECG: show AF, previous MI
• CXR: Pacemaker, right cardiomegaly, pleural/pericardial effusion
• LFTs: assess liver function
• FBC: Assess anaemia of chronic disease or thrombocytopenia (due to liver dysfunction)