Tricuspid Regurgitation
#CausesofTricuspid #TricuspidRegurgitation #TricuspidPrevent
Causes of Tricuspid Regurgitation
Mnemonic: Functional REP-C
| Functional dilatation of tricuspid annulus due to RVF R: Rheumatic heart disease, Radiation E: Endomyocardial fibroelastosis and Ebstein anomaly (Lithium teratogenicity) P: Pulmonary artery hypertension severe causing RVF P: Pacing lead induced damage C: Carcinoid syndrome
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Clinical features
- Effort intolerance due to less pulmonary blood flow
- Visible neck pulsations
- Abdominal fullness and reduced appetite
Examination findings
- Lancisi sign / cv wave/ prominent v waves
- Absent x descent
- Prominent y descent (Contrast with blunted Y of tricuspid stenosis)
- Pulsatile liver (Systolic pulsations)
- Pan-systolic murmur that increases on deep inspiration ( carvallo sign)
Work up
- ECG shows
-Right axis deviation
-Right atrial enlargement of P pulmonale
-WPW syndrome can co-exist in Ebstein anomaly and hence ECG findings of delta wave with short PR interval can be present
- CXR shows RV enlargement
- IOC is trans-esophageal echocardiography
- Doppler shows reversed systolic flow in liver
Management
- Salt restricted diet
- Diuretics
- Tricuspid valve repair (TVRp)
- Tricuspid valve replacement (TVR)