In tricuspid regurgitation blood leaks back from the right ventricle into the right atrium with each beat. Most cases are secondary to a dilated right ventricle from pulmonary hypertension, left heart disease or atrial fibrillation, while endocarditis in people who inject drugs is a key primary cause.
Key symptoms
- Fatigue and reduced exercise tolerance
- Leg swelling
- Abdominal fullness, right upper abdominal discomfort and early satiety
- Pulsing felt in the neck
What you find on exam
- Holosystolic murmur at the left lower sternal border that gets louder on inspiration
- Raised jugular venous pressure with large v waves
- Pulsatile, enlarged liver; ascites and leg edema
- Fever and injection marks suggest endocarditis
Tests
- Echocardiogram: severity, right ventricle size and pulmonary pressure
- ECG: atrial fibrillation or right heart strain
- Liver tests and kidney function
- Blood cultures if fever or injection drug use
Treatment basics
- Loop diuretic such as furosemide for congestion
- Treat the cause: left heart disease, pulmonary hypertension, atrial fibrillation
- Endocarditis: IV antibiotics guided by cultures
- Surgical repair or transcatheter therapy for severe symptomatic cases or during left-sided valve surgery
Red flags
- Fever with a new murmur in someone who injects drugs
- Jaundice or rising creatinine from congestion
- Low blood pressure or fainting
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; Stanford Medicine 25 (bedside exam). Written by Making Synapses. Making Synapses is not affiliated with these organizations.