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Tricuspid regurgitation

Last reviewed: 1 Nov 2024
Last updated: 05 Nov 2024

Summary

Definition

History and exam

Key diagnostic factors

  • fatigue and effort intolerance
  • dyspnea
  • palpitations
  • jugular venous abnormality
  • irregular heart rhythm
  • parasternal systolic murmur
  • increased systolic murmur on inspiration (Carvallo sign)
  • peripheral edema
Full details

Other diagnostic factors

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

Risk factors

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

Diagnostic tests

1st tests to order

  • transthoracic or transesophageal echocardiogram
  • ECG
  • LFTs
  • serum BUN and creatinine
  • CBC
  • CXR
Full details

Tests to consider

  • operative transesophageal echocardiogram
  • postoperative transthoracic echocardiogram
  • cardiac catheterization
  • 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 Surgery

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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