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Condition/Disorder Synonyms

  • Tricuspid valve regurgitation (TR)

  • Tricuspid valve insufficiency (TI)

ICD-9-CM Code

  • 397.0 Diseases of tricuspid valve

ICD-10-CM Codes

  • I07.1 Rheumatic tricuspid insufficiency

  • I36.1 Nonrheumatic tricuspid (valve) insufficiency

Preferred Practice Pattern

Key Features

Description

  • 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

Essentials of Diagnosis

  • 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

General Considerations

  • 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

Demographics

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

Clinical Findings

Signs and Symptoms

  • Jugular venous distension

  • Weakness

  • Fatigue

  • Endocarditis

  • Cirrhosis

  • Weight loss

  • Swelling

    • Abdomen

    • Liver

    • Spleen

    • Peripheral edema

    • Feet

    • Ankles

  • Decreased urine output

  • Heart murmur

Functional Implications

  • 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

Possible Contributing Causes

  • 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

Differential Diagnosis

  • 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

Means of Confirmation or Diagnosis

Imaging

  • Echocardiography to measure blood pressure inside the heart and lungs

  • MRI of the heart

  • Chest x-ray

    • Enlarged left atrium

    • Enlarged left ventricle

  • EKG

Diagnostic Procedures

  • Cardiac catheterization

    • Assessment of coronary artery disease, EF, pulmonary artery wedge pressure

  • Phonocardiogram

Findings and Interpretation

  • 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 ...

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