Tricuspid regurgitation
| Tricuspid insufficiency | |
|---|---|
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| Tricuspid regurgitation | |
| Classification and external resources | |
| Specialty | Cardiology |
| ICD-10 | I07.1, I36.1, Q22.8 |
| ICD-9-CM | 397.0 |
| MedlinePlus | 000169 |
| eMedicine | med/2314 |
| MeSH | D014262 |
Tricuspid insufficiency (TI), a valvular heart disease also called tricuspid regurgitation (TR), refers to the failure of the heart's tricuspid valve to close properly during systole. This defect allows the blood to flow backwards, reducing its efficiency. Regurgitation may be due to a structural change of components of the tricuspid valve apparatus, a lesion can be primary (intrinsic abnormality) or secondary (right ventricular dilatation).
Signs/symptoms of tricuspid insufficiency are generally those of right-sided heart failure, such as ascites and peripheral edema.
Tricuspid insufficiency may lead to the presence of a pansystolic heart murmur. Such a murmur is usually of low frequency and best heard low on the lower left sternal border. As with most right-sided phenomena, it tends to increase with inspiration, and decrease with expiration.However, the murmur may be inaudible indicating the relatively low pressures in the right side of the heart. A third heart sound may also be present, also heard with inspiration at the lower sternal border.
In addition to the possible ausculatory findings above, there are other signs indicating the presence of tricuspid regurgitation. There may be giant C-V waves in the jugular pulse and a palpably (and sometimes visibly) pulsatile liver on abdominal exam. Since the murmur of tricupsid regurgitation may be faint or inaudible, these signs can be helpful in establishing the diagnosis.
The causes of tricuspid insufficiency can be congenital in origin. Much more common than a congenital abnormality of the valve, however, is right ventricular dilatation of any cause. Such dilatation is most often the result left heart failure (of any cause) or pulmonary hypertension. Dilation leads to derangement of the normal anatomy and mechanics of the tricuspid valve and the muscles governing its proper function, with the result being incompetence of the tricuspid valve. Other common causes of right ventricular dilation include right ventricular infarction, inferior myocardial infarction, and cor pulmonale.
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