Regurgitation, tricuspid (TR)

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

• 397.0 Diseases of tricuspid valve

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

• 6D: Impaired aerobic capacity/endurance associated with cardiovascular pump dysfunction or failure1

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)

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

• 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

• 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

• 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

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

• 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

Medication

• 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

Medical Procedures

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