Tricuspid regurgitation is backflow of blood from the right ventricle (RV) to the right atrium (RA) during systole due to improper closure of the tricuspid valve.
Most Common Cause: Pulmonary Hypertension & Rheumatic Heart Disease (RHD)
Mnemonic: "TR = Tricuspid Returns Blood (to RA)"
CAUSES OF
TRICUSPID REGURGITATION
1. Primary
(Organic TR – Valve Damage)
• Rheumatic Heart Disease (Most Common in India).
• Infective Endocarditis (Common in IV Drug Users).
• Ebstein’s Anomaly (Congenital TR – Valve Displaced Downwards).
Mnemonic: "R.I.E." (Rheumatic, Infection, Ebstein’s Anomaly)
2. Secondary
(Functional TR – Due to RV Dilatation)
• Left Heart Failure (Leads to RV Overload).
• Pulmonary Hypertension (Cor Pulmonale).
• Right Ventricular Infarction.
Mnemonic: "L.P.R." (Left Heart Failure, Pulmonary HTN, RV Infarct)
PATHOPHYSIOLOGY
OF TR
1. Tricuspid
Valve Fails to Close → Blood Leaks Back into RA.
2. Right Atrium
& Right Ventricle Dilate (Due to Volume Overload).
3. Venous
Congestion → Hepatomegaly, Edema, Jugular Venous Distension (JVD).
4. Late Stage →
Right Heart Failure (Severe Swelling & Liver Dysfunction).
Mnemonic: "B.R.V.L." (Backflow → RA & RV Dilate → Venous Congestion → Late Stage Right HF)
SYMPTOMS OF
TRICUSPID REGURGITATION
• Fatigue & Weakness (Low Cardiac Output).
• Swelling of Legs & Abdomen (Edema, Ascites).
• Neck Vein Distension (Prominent Jugular Pulsations).
• Right Upper Abdomen Pain (Hepatic Congestion).
• Loss of Appetite (Due to GI Congestion).
Mnemonic: "F.S.N.H.L." (Fatigue, Swelling, Neck Pulsations, Hepatic Pain, Loss of Appetite)
SIGNS &
MURMURS IN TR
Jugular Venous Pulse (JVP):
- Prominent ‘v’ Wave (Backflow into RA).
- Inspiration Increases JVP (Kussmaul’s
Sign).
Heart Sounds:
- Soft S1 (Tricuspid Valve Not Closing
Properly).
- S3 Gallop (Due to RV Overload).
Murmur:
- Pansystolic (Holosystolic) Murmur →
Best Heard at Left Lower Sternal Border.
- Murmur Increases with Inspiration
(Carvallo’s Sign – Key Feature of TR).
Mnemonic: "V.I.C." (V Wave in JVP, Inspiration Increases Murmur, Carvallo’s Sign)
DIAGNOSIS OF
TRICUSPID REGURGITATION
ECG:
- Right Ventricular Hypertrophy (RVH).
- Atrial Fibrillation (Common in Severe
TR).
Chest X-ray:
- Enlarged Right Atrium & Right
Ventricle.
Echocardiography (Best Test!)
- Confirms Tricuspid Regurgitation &
Measures Pulmonary HTN.
Mnemonic: "E.C.E." (ECG, CXR, Echo – Best Test)
TREATMENT OF TRICUSPID
REGURGITATION
1. MEDICAL
TREATMENT (For Mild-Moderate TR)
- Diuretics (Reduce Swelling & Congestion).
- Digoxin (Improves Right Heart Function).
- ACE Inhibitors (For Heart Failure).
Mnemonic: "D.D.A." (Diuretics, Digoxin, ACE Inhibitors)
2. SURGICAL
TREATMENT (For Severe TR or Symptoms)
- Tricuspid Valve Repair (Annuloplasty – Tightening the Valve Ring).
- Tricuspid Valve Replacement (If Valve is Too Damaged).
Mnemonic: "R.R." (Repair or Replace Valve in Severe TR)
COMPLICATIONS OF
TR
• Right Heart Failure (Swelling, Ascites, Hepatic Congestion).
• Atrial Fibrillation (Due to RA Enlargement).
• Liver Dysfunction (Severe Hepatic Congestion).
• Endocarditis (If Due to IV Drug Use).
Mnemonic: "R.A.L.E." (Right HF, AFib, Liver Dysfunction, Endocarditis)
DIFFERENTIAL
DIAGNOSIS (CONDITIONS THAT MIMIC TR)
- Mitral Regurgitation (MR): Murmur Does NOT Increase on Inspiration (Unlike TR).
- Right Ventricular Infarct: No Prominent JVP Pulsations.
- Pulmonary Stenosis (PS): Systolic Murmur, But NO Holosystolic Murmur.
Mnemonic: "M.R.P." (Mitral Regurg, RV Infarct, Pulmonary Stenosis)
PREVENTION OF
TRICUSPID REGURGITATION
- Early Treatment of Rheumatic Fever (Penicillin Prophylaxis).
- Control Pulmonary Hypertension (To Prevent Functional TR).
- Avoid IV Drug Use (To Prevent Infective Endocarditis).
Mnemonic: "P.C.A." (Penicillin, Control Pulmonary HTN, Avoid Drugs)
FINAL REVISION WITH MNEMONICS
- Definition = "TR = Tricuspid Returns Blood (to RA)"
- Causes = "R.I.E." (Rheumatic, Infection, Ebstein’s Anomaly) & "L.P.R." (Left HF, Pulmonary HTN, RV Infarct)
- Pathophysiology = "B.R.V.L." (Backflow → RA & RV Dilate → Venous Congestion → Late Stage Right HF)
- Symptoms = "F.S.N.H.L." (Fatigue, Swelling, Neck Pulsations, Hepatic Pain, Loss of Appetite)
- Signs & Murmurs = "V.I.C." (V Wave in JVP, Inspiration Increases Murmur, Carvallo’s Sign)
- Diagnosis = "E.C.E." (ECG, CXR, Echo – Best Test)
- Medical Treatment = "D.D.A." (Diuretics, Digoxin, ACE Inhibitors)
- Surgical Treatment = "R.R." (Repair or Replace Valve in Severe TR)
- Complications = "R.A.L.E." (Right HF, AFib, Liver Dysfunction, Endocarditis)
- Differential Diagnosis = "M.R.P." (Mitral Regurg, RV Infarct, Pulmonary Stenosis)
- Prevention = "P.C.A." (Penicillin, Control Pulmonary HTN, Avoid Drugs)
