Congenital Structural Abnormalities: Conditions like Ebstein’s anomaly result in structural issues with the valve.
Dilation of Valve Ring: Typically secondary to right ventricular (RV) enlargement or dilatation due to increased pressure.
Infections and Valve Disruption:
- Rheumatic Heart Disease
- Endocarditis (particularly staphylococcal infections in IV drug users)
- Carcinoid Syndrome: Causes fibrous deposits on the valve leaflets and subvalvular apparatus
- Ebstein's Anomaly: Congenital displacement and deformation of the tricuspid valve
Secondary Causes:
- Ischemic Heart Disease
- Cor Pulmonale: Right-sided heart failure secondary to lung disease
- Pulmonary Hypertension: Increased pressures lead to RV dilation, affecting the tricuspid valve's function

Causes

Congenital: Ebstein's Anomaly
Pulmonary Hypertension: Resulting in RV dilation due to left heart failure or chronic lung disease
Infective Endocarditis: Often seen in IV drug users, with staphylococcal infections commonly causing septic pulmonary emboli
Rheumatic Heart Disease: Often associated with coexisting mitral or aortic disease
Carcinoid Syndrome: Leads to plaque-like deposits on valve leaflets, limiting valve movement
Medications: Drugs like pergolide (for Parkinson’s disease) and methysergide

🩺 Clinical Features

Symptoms: Fatigue, hepatic discomfort (RUQ pain), signs of right-sided heart failure (e.g., ankle edema, ascites)
Physical Signs:
- JVP: Systolic V wave and rapid Y descent
- Heart Sounds: Pansystolic murmur (PSM) at the left sternal edge (LSE), louder on inspiration
- Other Signs: Pulsatile liver, peripheral cyanosis, RV heave, and ankle edema

🔎 Investigations

Blood Tests:
- FBC, U&E: To monitor baseline organ function
- ↑ WCC, CRP, and ESR: Elevated levels suggest endocarditis
- Liver Function Tests (LFTs): Elevated values can indicate hepatic congestion
Blood Cultures: Recommended if endocarditis is suspected
ECG Findings: Atrial fibrillation (AF), P pulmonale, RV hypertrophy, or right bundle branch block (RBBB)
Echocardiography: Visualizes valve dysfunction and estimates right-sided pressures
Right Heart Catheterization: Directly measures right atrial and RV pressures, useful for assessing the severity of TR

💊 Management

Treat the Underlying Cause: Address any infection or underlying condition contributing to TR, such as endocarditis (see specific guidelines).
Medications:
- Diuretics: To manage fluid overload and relieve symptoms of heart failure.
- Digoxin: Useful for rate control, especially if associated with AF. Anticoagulation (e.g., warfarin) may be indicated.
Surgical Intervention:
- Valve Repair or Replacement: Indicated if TR is severe and not responding to medical management. Particularly important if TR is secondary to an isolated valve defect.
- Excision of Valve: In endocarditis, complete excision may be necessary. Well tolerated in the short-to-medium term.
- Ebstein’s Anomaly: Symptomatic patients may benefit from valve repair or replacement.

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Tricuspid Regurgitation

ℹ️ About

🧬 Aetiology

Causes

🩺 Clinical Features

🔎 Investigations

💊 Management

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