Tricuspid regurgitation

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Contributors: Christine Osborne MD, Ryan Hoefen MD, PhD

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Synopsis

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Refers to the backflow of blood from the right ventricle (RV) to the right atrium due to insufficiency of the tricuspid valve. In 80% of cases, tricuspid regurgitation (TR) is due to dilation of the tricuspid annulus from RV dilation in the setting of pulmonary arterial hypertension.

Other causes of TR include inferior myocardial infarction (MI), heart failure secondary to rheumatic heart disease (see rheumatic fever), heart failure secondary to congenital heart disease with severe pulmonary artery hypertension, ischemic cardiomyopathy (see coronary artery disease), idiopathic dilated cardiomyopathy, infarction of the RV papillary muscles, tricuspid valve prolapse, infective endocarditis, radiation, endomyocardial fibrosis, or leaflet trauma. The most commonly associated congenital heart disease occurs with Ebstein malformation of the tricuspid valve.

Symptoms of tricuspid regurgitation include exertional dyspnea, fatigue, abdominal fullness, decreased appetite, lower extremity edema, and progressive weight gain. Physical examination reveals prominent c-v waves with rapid y descents, hepatomegaly with hepatojugular reflex, ascites, pleural effusions, peripheral edema, and a blowing holosystolic murmur along the lower left sternal border, typically with atrial fibrillation.

Codes

ICD10CM:
I36.1 – Nonrheumatic tricuspid (valve) insufficiency

SNOMEDCT:
111287006 – Tricuspid valve regurgitation

Differential Diagnosis & Pitfalls

• Pulmonary hypertension
• Pulmonary embolism
• Chronic obstructive pulmonary disease
• Congestive heart failure
• Pericardial effusion
• Liver failure
• Renal failure (acute, chronic)

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