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  • Tricuspid valve regurgitation (TR)
  • Tricuspid valve insufficiency (TI)

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  • 397.0 Diseases of tricuspid valve

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  • I07.1 Rheumatic tricuspid insufficiency
  • I36.1 Nonrheumatic tricuspid (valve) insufficiency

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Description

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  • Tricuspid valve does not close properly during systole
  • Causes a backflow and fluid overload in the right atrium
  • Fluid overload in the right atrium can lead to weakening of the right atrial wall
  • Usually asymptomatic
  • Irregular heart beat

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Essentials of Diagnosis

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  • Stethoscope for auscultation of a pansystolic heart murmur at lower left sternal border
  • Echocardiography
  • EKG/ECG
  • CT/MRI for enlargement of the right side of the heart
  • Cardiac catheterization
  • Chest x-ray
  • Exercise stress test

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General Considerations

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  • Signs and symptoms should be monitored
  • Mild to moderate regurgitation generally does not cause symptoms.
  • Symptoms often weakness and fatigue
  • Patients can develop bacterial endocarditis

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Demographics

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  • Seen in individuals with Ebstein’s anomaly (congenital heart disease)

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  • Jugular venous distension
  • Weakness
  • Fatigue
  • Endocarditis
  • Cirrhosis
  • Weight loss
  • Swelling
    • Abdomen
    • Liver
    • Spleen
    • Peripheral edema
    • Feet
    • Ankles
  • Decreased urine output
  • Heart murmur

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  • Symptoms depend on degree of valvular dysfunction
  • Mild to moderate regurgitation generally does not cause symptoms
  • Severe regurgitation causes fatigue, weakness, and signs of congestive heart failure
  • Patients may be unaware of their reduced cardiovascular capacity
  • Can cause syncope, chest pain, and heart failure if untreated

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  • Tricuspid valve prolapse
  • Enlargement of the right ventricle
  • Right ventricular infarction
  • Inferior myocardial infarction
  • Cor pulmonale
  • Infective endocarditis
  • Drug abuse
  • Diet medication: phentermine and fenfluramine
  • Bacteria in the blood stream
  • Pulmonary hypertension
  • Ebstein’s anomaly (congenital heart disease)
  • Marfan syndrome
  • Rheumatoid arthritis
  • Rheumatic fever
  • Systemic lupus erythematosus

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  • Acute coronary syndrome
  • Aortic regurgitation
  • Aortic stenosis
  • Mitral valve prolapse
  • Mitral stenosis
  • Myocardial infarction complication
  • Shock, hypovolemia
  • Cardiac pump dysfunction
  • Cardiac muscle dysfunction
  • Cardiac pump failure

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Imaging

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  • Echocardiography to measure blood pressure inside the heart and lungs
  • MRI of the heart
  • Chest x-ray
    • Enlarged left atrium
    • Enlarged left ventricle
  • EKG

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Diagnostic Procedures

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  • Cardiac catheterization
    • Assessment of coronary artery disease, EF, pulmonary artery wedge pressure
  • Phonocardiogram

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  • Elevated jugular venous pressure
  • Backflow of blood into left atrium during systole
  • Left ventricular dysfunction
  • Possible increase in left pulmonary venous pressure
  • Pansystolic murmur at the lower left sternal border

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Medication

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  • Medications for heart failure induced by tricuspid regurgitation:
    • Diuretics
    • Beta-blockers
    • Positive inotropic agents
    • Angiotensin-converting enzyme
    • Aldosterone antagonists
    • Antibiotics for patients with a history of rheumatic fever
    • Vasodilators like nitroprusside and hydralazine to decrease afterload
    • Inpatient pharmacologic management

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Medical Procedures

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  • Internal cardiac defibrillator
  • Tricuspid valve replacement/repair
  • Cardiac resynchronization
  • Coronary artery bypass
  • Left or right ventricular assisting device
  • Cardiac transplant

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