Tricuspid regurgitation

Published on 02/04/2015 by admin

Filed under Internal Medicine

Last modified 22/04/2025

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19 Tricuspid regurgitation

Instruction

Examine this patient’s heart.

Examine this patient’s cardiovascular system.

Salient features

History

• Intravenous drug abuse

• Trauma to the chest

• Rheumatic fever

• COPD.

Examination

• Peripheral cyanosis

• Large ‘v’ waves in the jugular venous pulse (Fig. 19.1)

• Left parasternal heave

• Palpable or loud P2

• Pansystolic murmur at the left lower sternal border, which increases in inspiration (Carvallo’s sign)

• Right ventricular third heart sound may be present

• Atrial fibrillation may be present

• Proceed by looking for:

• mid-diastolic murmur of mitral stenosis
• systolic pulsations of an enlarged liver
• ascites and ankle oedema.
image

Fig. 19.1 Jugular venous pulse in tricuspid regurgitation (TR). The jugular venous pulse wave normally drops during ventricular systole. As TR becomes more severe, the CV wave becomes more obvious.

Diagnosis

This patient has tricuspid regurgitation (lesion) secondary to chronic lung disease and cor pulmonale (aetiology of the lesion) and is in cardiac failure (functional status).

Questions

What are the causes of tricuspid regurgitation?

• Functional:

• Pulmonary hypertension
• Congestive cardiac failure.

• Rheumatic (associated with mitral and/or aortic valve disease)

• Right heart endocarditis as in drug addicts

• Uncommon: carcinoid syndrome, Ebstein’s anomaly, endomyocardial fibrosis, infarction of right ventricular papillary muscles, tricuspid valve prolapse, blunt trauma to the heart.

How would you treat organic tricuspid regurgitation?

Surgically with:

• valve plication or annuloplasty

• valve replacement.

How is tricuspid regurgitation quantified?

On echocardiography it is quantified by colour Doppler imaging into:

• mild: flow disturbance in systole localize to the area adjacent to the vale closure plane (jet area <5 cm2)

• moderate: fills between 5 and 10 cm2 of the right atrium

• severe: fills >10 cm2 of the enlarged right atrium.

JMR Carvallo, Mexican cardiologist who worked in Mexico City (Rivero-Carvallo JM (1946) Signo para el diagnostico de las insuficiencias tricuspideas. Arch Inst Cardiol Mex 16:531).

[/level-membership-for-internal-medicine-category][not-level-membership-for-internal-medicine-category]

19 Tricuspid regurgitation

Instruction

Examine this patient’s heart.

Examine this patient’s cardiovascular system.

Salient features

History

• Intravenous drug abuse

• Trauma to the chest

• Rheumatic fever

• COPD.

Examination

• Peripheral cyanosis

• Large ‘v’ waves in the jugular venous pulse (Fig. 19.1)

• Left parasternal heave

• Palpable or loud P2

• Pansystolic murmur at the left lower sternal border, which increases in inspiration (Carvallo’s sign)

• Right ventricular third heart sound may be present

• Atrial fibrillation may be present

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