Tricuspid regurgitation

Last reviewed: 28 Aug 2022
Last updated: 11 Aug 2022

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
More key diagnostic factors

Other diagnostic factors

  • abdominal distension
  • early satiety, dyspepsia, or indigestion
  • liver pulsation
Other diagnostic factors

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
More risk factors

Diagnostic investigations

1st investigations to order

  • transthoracic or transoesophageal echocardiogram
  • ECG
  • LFTs
  • serum urea and creatinine
  • FBC
  • CXR
More 1st investigations to order

Investigations to consider

  • operative transoesophageal echocardiogram
  • postoperative transthoracic echocardiogram
  • cardiac catheterisation
  • cardiac MRI (preferred technique for evaluation of right ventricular size and function)
More investigations to consider

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

Disclosures

LAW declares that he has no competing interests.

Prakash P. Punjabi, MB BS

Consultant Cardiothoracic Surgeon

Imperial College Healthcare NHS Trust

London

UK

Disclosures

PPP declares that he has no competing interests.

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