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17: TRICUSPID REGURGITATION

Eric Shamus, PhD, DPT, PT, CSCS; Natalie V. Wessel, DO, MPH

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

  • 6D: Impaired Aerobic Capacity/Endurance Associated with Cardiovascular Pump Dysfunction or Failure1

PATIENT PRESENTATION

A 65-year-old male presents to physical therapy for weakness, pulsations in the neck, and fatigue. He has a history of mild hypertension that is well controlled on lisinopril. Vitals are: Pulse: 70, Respirations: 14, Blood Pressure: 124/84, Temperature: 97.9°F, and SpO2% of 96%. On physical examination, there is mild distension of the jugular veins on the right side of the neck and a palpable right ventricular heave. On auscultation, there is a holosystolic murmur at the right mid-sternal border. With leg raising the murmur gets louder. The patient was referred to the cardiologist. ECG and chest X-ray show signs of right atrial and ventricular enlargement. Echocardiography reveals a vena contracta of 0.8 cm and a dilated tricuspid annulus.

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 heartbeat

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

FIGURE 17-1

A Doppler signal due to the severe tricuspid regurgitation. In tricuspid regurgitation, the high-velocity flow is recorded during systole and not in diastole (Dias). Because the jet of tricuspid regurgitation is flowing away from the transducer, a negative signal is recorded. The simplified Bernoulli equation can be used to estimate the pressure difference between the right ventricle and the right atrium from the peak velocity recorded from the tricuspid regurgitation signal (3.74 m/s or 374 cm/s). (From Nicoll D, Lu CM, Pignone M, et al. Pocket Guide to Diagnostic Tests. 6th ed. www.accessmedicine.com. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.)

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General Considerations

  • Signs and symptoms should be monitored

  • Mild-to-moderate regurgitation generally does not cause symptoms

  • Symptoms are often weakness and fatigue

  • Patients can develop bacterial endocarditis

Demographics

  • Seen in individuals with Ebstein 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

    ...

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