TR

Question 1

definition of TR

Answer 1

backflow of blood from the right ventricle to the right atrium during systole.

Question 2

aetiology of TR

Answer 2

congenital

• Ebstein anomaly - malpositioned tricuspid valve
• cleft valve in ostium primum defect
• ASD
• AV canal

functional

• consequence of RV dilation eg in pul hypertension induced by LV failure or PE
• valve prolapse

rheumatic heart disease - associated with other valvular disease

infective endocarditis - common in IVDU, usually staph

carcinoid syndrome

trauma

cirrhosis (long-standing)

iatrogenic eg radiotherapy to the thorax

drugs - ergot-derived dopamine agonists, fenfluramine

Question 3

epidemiology of TR

Answer 3

The epidemiology differs with various causes.

Infective endocarditis probably most common cause.

Question 4

sx of TR

Answer 4

• fatigue
• breathlessness
• palpitations
• headaches
• nausea
• anorexia
• epigastric/hepatic (due to hepatic congestion) pain made worse by exercise
• jaundice
• ascites
• lower limb swelling

Question 5

signs of TR

Answer 5

irregularly irregular pulse due to AF (occur with RA enlargement)

raised JVP

• giant V waves which may oscillate to the earlobe, caused by transmission of the RV pressure to the great veins
• might be giant a wave of pt is in sinus rhythm
• prominent y descent

RV parasternal heave

Pansystolic murmur heard best at the lower left sternal edge, louder on inspiration (Carvallo sign).

Loud P2 component of second heart sound.

chest

• pleural effusion
• causes of pul hypertension eg emphysema

abdo

• Palpable liver (tender, smooth, pulsatile)
• ascites.

legs - pitting oedema

Question 6

Ix for TR

Answer 6

blood - FBC, LFT, cardiac enzymes, blood cultures

ECG

• Tall P wave (right atrial hypertrophy) if in sinus rhythm.
• Changes indicative of other cardiac disease.

CXR - R sided enlargement of cardiac shadow

echo

• Extent of regurgitation estimated by colour flow Doppler.
• May be able to detect tricuspid valve abnormality (e.g. prolapse)
• right ventricular dilation.

R heart catheterisation - Rarely necessary, may be considered to assess pulmonary artery pressure.