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.
As a result, with each heart beat some blood passes from the right ventricle
to the right atrium, the opposite
of the normal direction. Tricuspid regurgitation occurs in roughly less than 1%
of people and is usually asymptomatic.
Causes:
[A] Primary:
·
Rheumatic heart disease.
·
Endocarditis, particularly in
intravenous drug-users.
·
Ebstein’s congenital anomaly.
[B] Secondary:
·
Right ventricular dilatation due to
chronic LHF.
·
Right ventricular infraction.
·
Pulmonary hypertension (e.g. co
pulmonary)
Clinical
features:
Symptoms:
Symptoms are usually non-specific and related to reduced forward flow
(tiredness) & venous congestion (oedema, hepatic enlargement)
Signs:
1.
Raised JVP.
2.
Large systolic wave in JVP ( CV wave
replaces the x descent)
3.
Systolic pulsation over the liver.
4.
Pansystolic murmur (at left sterna
edge): Louder on inspiration.
Investigations:
1.
Chest X-ray: Dilated right atrium &
right ventricle.
2.
Echo:
·
Right ventricular dilatation.
·
Tricuspid valve may be structurally
abnormal (Rh disease)
·
Estimate PA pressure from Doppler.
Diagnosis: Diagnosis is usually made
by echocardiography identifying tricuspid prolapse or flail. The finding of a
pulsatile liver and/or the presence of prominent CV waves in the jugular pulse
is also essentially diagnostic.
Electrocardiography assists in the diagnosis,
indicating enlargement of right ventricle and atrium.
Management:
[A] TR due to right
ventricular dilatation:
·
Diuretics and vasodilators or
·
Mitral valve replacement.
[B] Sever organic
tricuspid valve damage & elevated pulmonary artery pressure require
tricuspid valve repair (annuloplasty or placation) & very occasionally
tricuspid valve replacement may be necessary.
Reference:
1.
Davidson’s Principles and practice of
Medicine, 21st edition.
2.
Wikipedia the free encyclopedia.
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