Tricuspid regurgitation
Tricuspid regurgitation is systolic backflow from the right ventricle into the right atrium, most often secondary (functional) from right ventricular or annular dilation and pulmonary hypertension. It causes right-sided congestion with a prominent jugular v wave and a systolic murmur that increases on inspiration; management targets the underlying cause and, in selected severe disease, valve intervention.
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What this article covers
- Overview
Definition: tricuspid regurgitation is systolic reflux of blood from the right ventricle into the right atrium, classified as primary (intrinsic valve disease) or, more commonly, secondary/functional…
- Epidemiology
Common, and most often secondary (functional).
- Risk factors
Left heart disease and pulmonary hypertension (functional regurgitation).
- Pathophysiology
Functional mechanism: right ventricular or annular dilation and leaflet tethering prevent coaptation despite normal leaflets.
- Clinical features
Fatigue and right-sided congestion: peripheral edema, ascites, and a pulsatile, tender liver.
- Differential diagnosis
Mitral regurgitation: an apical systolic murmur radiating to the axilla, distinguished from tricuspid regurgitation by the absence of inspiratory augmentation (negative Carvallo sign) (Mitral regurgitation).
- Diagnosis
Establish and grade with echocardiography assessing the jet, vena contracta, and right heart size and function, and estimating pulmonary pressure: the diagnostic basis is echocardiography defining…
- Management
First-line, treat the underlying cause and relieve congestion: optimize therapy for left heart disease and pulmonary hypertension, control atrial fibrillation, restrict sodium, and reduce congestion…
- Complications
Progressive right heart failure, ascites, and cardiac cirrhosis.
- Prognosis
Depends on the underlying cause and right ventricular function.
- Prevention
Treat left heart disease and pulmonary hypertension to prevent functional regurgitation.
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Related articles
- Tricuspid stenosis
Tricuspid stenosis is obstruction of right atrial emptying from a narrowed tricuspid valve, almost always rheumatic and usually accompanying mitral stenosis. It causes right-sided congestion with a prominent jugular a wave and a diastolic murmur that increases with inspiration; severe symptomatic disease is treated with valve repair or replacement.
- Right heart failure
Right heart failure is inability of the right ventricle to maintain output at acceptable filling pressures, most often from left heart failure or pulmonary hypertension, and acutely from pulmonary embolism or right ventricular infarction. It causes systemic venous congestion, and management centers on the underlying cause, careful volume and afterload optimization, and preload-dependent support in acute disease.
- Mitral regurgitation
Mitral regurgitation is systolic backflow from the left ventricle into the left atrium, classified as primary (valve disease) or secondary (ventricular or annular disease). Chronic disease causes volume overload with an apical holosystolic murmur, while acute severe regurgitation causes pulmonary edema; severe primary disease is treated with valve repair or replacement.
- Ventricular septal defect
Ventricular septal defect is a hole in the interventricular septum causing a left-to-right shunt, the most common congenital heart defect. Small defects produce a loud murmur but close spontaneously, while large defects cause heart failure and pulmonary hypertension and require closure before irreversible pulmonary vascular disease (Eisenmenger physiology) develops.
- Constrictive pericarditis
Constrictive pericarditis is a rigid, often calcified pericardium that impairs diastolic filling, causing predominantly right-sided heart failure. It follows pericardial injury (post-surgical, tuberculous, radiation, or idiopathic), is distinguished from restrictive cardiomyopathy by hemodynamic and imaging features, and definitive treatment is pericardiectomy.
- Restrictive cardiomyopathy
Restrictive cardiomyopathy is impaired ventricular filling from a stiff, noncompliant myocardium with preserved (or near-preserved) systolic function and non-dilated ventricles, most often from infiltration such as amyloidosis. It presents as predominantly right-sided heart failure, and diagnosis centers on echocardiography and cardiac MRI plus a search for the underlying cause, distinguishing it from constrictive pericarditis; management treats the underlying cause with cautious diuresis.