Tricuspid regurgitation

• Alternative Names

  Tricuspid insufficiency

• Causes, incidence, and risk factors

  The tricuspid valve separates the right lower heart chamber (the right ventricle) from the right upper heart chamber (right atrium).

  The most common cause of tricuspid regurgitation is swelling of the right ventricle. Such swelling may be a complication of any disorder that causes failure of the right ventricle.

  Other diseases can directly affect the tricuspid valve. The most common of these is rheumatic fever, which is a complication of untreated strep throat infections.

  Tricuspid regurgitation affects about 4 out of 100,000 people. It may be found in those with a type of congenital heart disease called Ebstein's anomaly.

  Other infrequent causes of tricuspid regurgitation include:

  • Carcinoid tumors, which release a hormone that damages the valve
  • Marfan syndrome
  • Injury
  • Rheumatoid arthritis
  • Radiation therapy

  Another important risk factor for tricuspid regurgitation is use of the diet medications called "Fen-Phen" (phentermine and fenfluramine) or dexfenfluramine.

• Symptoms

  Tricuspid regurgitation may not cause any symptoms if the patient does not have pulmonary hypertension. If pulmonary hypertension and moderate to severe tricuspid regurgitation exist together, the following symptoms may result:

  • Active pulsing in the neck veins
  • Decreased urine output
  • Fatigue, tiredness
  • General swelling
  • Swelling of the abdomen
  • Swelling of the feet and ankles
  • Weakness
• Signs and tests

  The health care provider may detect abnormalities when when gently pressing with the hand (palpating) on your chest. The doctor may also feel a pulse over your liver. The physical exam may reveal liver and spleen swelling.

  Listening to the heart with a stethoscope shows a murmur or abnormal sounds.There may be signs of fluid collection in the abdomen.

  An ECG or echocardiogram may show swelling of the right side of the heart. Doppler echocardiography or right-sided cardiac catheterization are used to measure blood pressures inside the heart and lungs.

• Treatment

  Treatment may not be needed if there are few or no symptoms. Hospitalization may be required for diagnosis and treatment of severe symptoms. Underlying disorders should be identified and treated. Some people may be able to have surgery to repair or replace the tricuspid valve.

• Expectations (prognosis)

  Treatment of any underlying conditions, especially high blood pressure in the lungs and swelling of the right lower heart chamber, may correct the disorder. Surgical valve repair or replacement usually provides a cure. However, persons with severe tricuspid regurgitation that cannot be corrected may have a poor prognosis.

• Complications
  • Worsening of heart failure
  • Endocarditis
  • Cirrhosis
  • Weight loss
  • Loss of appetite
• Calling your health care provider

  Call your health care provider if symptoms of tricuspid regurgitation are present.

• Prevention

  Prompt treatment of disorders that can cause valve disease reduces your risk of tricuspid regurgitation. Treat strep infections promptly to prevent rheumatic fever.

  Any invasive procedure, including dental work and cleaning, can introduce bacteria into your bloodstream. The bacteria can infect a damaged mitral valve, causing endocarditis. Always tell your health care provider and dentist if you have a history of heart valve disease or congenital heart disease before treatment. Taking antibiotics before dental or other invasive procedures may decrease your risk of endocarditis.

• References
  Karchmer AW. Infectious endocarditis. In: Libby P, Bonow RO, Mann DL, Zipes DP, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 8th ed. St. Louis, Mo: WB Saunders; 2007:chap. 63.

Review Date: 5/12/2008

Reviewed By: Larry A. Weinrauch, MD, Assistant Professor of Medicine, Harvard Medical School, and Private practice specializing in Cardiovascular Disease, Watertown, MA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.