Tricuspid regurgitation

Definition

Blood that flows between different chambers of your heart must pass through a heart valve. These valves open up enough so that blood can flow through. They then close, keeping blood from flowing backward.

The tricuspid valve separates the right lower heart chamber (the right ventricle) from the right upper heart chamber (right atrium).

Tricuspid regurgitation is a disorder in which this valve does not close tight enough. This problem causes blood to flow backward into the right upper heart chamber (atrium) when the right lower heart chamber (ventricle) contracts.

Alternative Names

Tricuspid insufficiency; Heart valve - tricuspid regurgitation; Valvular disease - tricuspid regurgitation

Causes

An increase in size of the right ventricle is the most common cause of this condition. The right ventricle pumps blood to the lungs where it picks up oxygen. Any condition that puts extra strain on this chamber can cause it to enlarge. Examples include:

Tricuspid regurgitation may also be caused or worsened by infections, such as:

Less common causes of tricuspid regurgitation include:

Symptoms

Mild tricuspid regurgitation may not cause any symptoms. Symptoms of heart failure may occur, and can include:

Exams and Tests

The health care provider may find abnormalities when gently pressing with the hand (palpating) on your chest. The provider may also feel a pulse over your liver. The physical exam may show liver and spleen swelling.

Listening to the heart with a stethoscope may reveal a murmur or other abnormal sounds. There may be signs of fluid buildup in the abdomen.

An ECG or echocardiogram may show enlargement of the right side of the heart. Doppler echocardiography or right-sided cardiac catheterization may be used to measure blood pressure inside the heart and lungs.

Other tests, such as CT scan or MRI of the chest (heart), may reveal enlargement of the right side of the heart and other changes.

Treatment

Treatment may not be needed if there are few or no symptoms. You may need to go to the hospital to diagnose and treat severe symptoms.

Swelling and other symptoms of heart failure may be managed with medicines that help remove fluids from the body (diuretics).

Some people may be able to have surgery to repair or replace the tricuspid valve. Surgery is most often done as part of another procedure.

Treatment of certain conditions may correct this disorder. These include:

Outlook (Prognosis)

Surgical valve repair or replacement most often provides a cure in people who need an intervention.

The outlook is poor for people who have symptomatic, severe tricuspid regurgitation that cannot be corrected.

When to Contact a Medical Professional

Call your provider if you have symptoms of tricuspid regurgitation.

Prevention

People with abnormal or damaged heart valves are at risk for an infection called endocarditis. Anything that causes bacteria to get into your bloodstream may lead to this infection. Steps to avoid this problem include:

Prompt treatment of disorders that can cause valve or other heart diseases reduces your risk of tricuspid regurgitation.

References

Carabello BA. Valvular heart disease. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 75.

Nishimura. RA, Otto CM, Bownow RO, et al. 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Thorac Cardiovasc Surg. 2014;148(1):e1-e132. PMID: 24939033 www.ncbi.nlm.nih.gov/pubmed/24939033.

Otto CM, Bonow RO. Valvular heart disease. In: Mann DL, Zipes DP, Libby P, Bonow RO, Braunwald E, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 10th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 63.



Review Date: 2/24/2016
Reviewed By: Michael A. Chen, MD, PhD, Associate Professor of Medicine, Division of Cardiology, Harborview Medical Center, University of Washington Medical School, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.
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