Overview
Tricuspid regurgitation (TR) describes the inadequate closure of the tricuspid valve leading to the backflow of blood during systole.
Causes
- Myocardial infarction affecting the right ventricle
- Pulmonary hypertension and its causes (e.g COPD)
- Rheumatic fever
- Infective endocarditis, particularly intravenous drug users (IVDUs)
- Ebstein’s anomaly
- Connective tissue disorders (e.g. Marfan syndrome, Ehlers-Danlos syndrome)
Presentation
Some patients may be asymptomatic. Symptoms depend on the severity of TR. Features include:
- Pansystolic murmur that increases with inspiration and decreases with expiration
- Right-sided heart failure – results in systemic congestion:
- Peripheral oedema, classically ankle or sacral oedema
- Raised jugular venous pressure
- Hepatomegaly which may be pulsatile
- Weight gain due to fluid retention
- Anorexia
Investigations
Overview
- ECG:
- May show right atrial hypertrophy and tall, peaked p-waves
- Chest x-ray:
- May show cardiomegaly
- Echocardiography:
- Identifies tricuspid regurgitation
Management
Overview
Management involves treating heart failure and surgery may be considered in some patients.
Complications
- Right heart failure
- Arrhythmia
