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Tricuspid regurgitation

Last reviewed: 20 Aug 2025
Last updated: 21 Mar 2025

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • fatigue and effort intolerance
  • dyspnoea
  • palpitations
  • jugular venous abnormality
  • irregular heart rhythm
  • parasternal systolic murmur
  • increased systolic murmur on inspiration (Carvallo's sign)
  • peripheral oedema
Full details

Other diagnostic factors

  • abdominal distension
  • early satiety, dyspepsia, or indigestion
  • liver pulsation
Full details

Risk factors

  • left-sided heart failure
  • dilated tricuspid annulus
  • rheumatic heart disease
  • permanent pacemaker
  • endocarditis
  • carcinoid heart disease
  • pacemaker lead entrapment
  • ischaemic cardiomyopathy
  • constrictive pericarditis
  • congenital heart disease
  • toxins
  • rheumatoid arthritis
  • radiotherapy
  • trauma
  • Marfan's syndrome
  • tricuspid valve prolapse
Full details

Diagnostic investigations

1st investigations to order

  • transthoracic or transoesophageal echocardiogram
  • ECG
  • LFTs
  • serum urea and creatinine
  • FBC
  • CXR
Full details

Investigations to consider

  • operative transoesophageal echocardiogram
  • postoperative transthoracic echocardiogram
  • cardiac catheterisation
  • cardiac MRI (preferred technique for evaluation of right ventricular size and function)
Full details

Treatment algorithm

ACUTE

primary: mild or moderate

primary: severe

secondary: mild or moderate

secondary: severe

Contributors

Authors

Shahab A. Akhter, MD

Professor of Cardiothoracic

Division of Cardiac Surgery

Department of Cardiovascular Sciences

Brody School of Medicine

East Carolina University

Greenville

NC

Disclosures

SAA declares that he has no competing interests.

Paul Tang, MD, PhD

Assistant Professor

Department of Cardiac Surgery

University of Michigan

Ann Arbor

MI

Disclosures

PT declares that he has no competing interests.

Jarred Mondonedo, MD, PhD

Cardiothoracic Surgery Fellow

Department of Cardiac Surgery

University of Michigan

Ann Arbor

MI

Disclosures

JM declares that he has no competing interests.

Acknowledgements

Dr Shahab A. Akhter and Dr Paul Tang would like to gratefully acknowledge Dr Kevin L. Greason, Dr Sorin V. Pislaru, and Prof. Thoraf M. Sundt III, previous contributors to this topic.

Disclosures

KLG, SVP, and TMS declare that they have no competing interests.

Peer reviewers

Larry A. Weinrauch, MD

Assistant Professor of Medicine

Harvard Medical School

Watertown

MA

Divulgaciones

LAW declares that he has no competing interests.

Prakash P. Punjabi, MB BS

Consultant Cardiothoracic Surgeon

Imperial College Healthcare NHS Trust

London

UK

Divulgaciones

PPP declares that he has no competing interests.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

Referencias

Nuestros equipos internos de evidencia y editoriales colaboran con colaboradores expertos internacionales y revisores pares para garantizar que brindemos acceso a la información más clínicamente relevante posible.

Artículos principales

Shah PM, Raney AA. Tricuspid valve disease. Curr Probl Cardiol. 2008 Feb;33(2):47-84. Resumen

Vahanian A, Beyersdorf F, Praz F, et al; ESC/EACTS Scientific Document Group; ESC Scientific Document Group. 2021 ESC/EACTS guidelines for the management of valvular heart disease. Eur Heart J. 28 Aug 2021 [Epub ahead of print].Texto completo  Resumen

Lancellotti P, Moura L, Pierard LA, et al. European Association of Echocardiography recommendations for the assessment of valvular regurgitation. Part 2: mitral and tricuspid regurgitation (native valve disease). Eur J Echocardiogr. 2010 May;11(4):307-32.Texto completo  Resumen

Writing Committee Members., Otto CM, Nishimura RA, et al. 2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol. 2021 Feb 2;77(4):e25-e197.Texto completo  Resumen

Abbas M, Hamilton M, Yahya M, et al. Pulsating varicose veins!! The diagnosis lies in the heart. ANZ J Surg. 2006 Apr;76(4):264-6. Resumen

Artículos de referencia

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