Tricuspid regurgitation

Causes

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 enlargement of the right ventricle, which pumps blood to the lungs, where it picks up oxygen. This enlargement may be a complication of any disorder that causes extra strain on the right ventricle.

Tricuspid regurgitation may also be caused or made worse by problems with the valves on the left side of the heart (mitral or aortic valve) or the left ventricle (which pumps blood from the heart to the rest of the body). It may also be due to any cause of pulmonary hypertension (high pressure in the lung circulation).

Other diseases can directly affect the tricuspid valve. The most common of these is infective endocarditis, which is usually due to unsanitary conditions during drug abuse. Anything that causes bacteria to enter the bloodstream can also cause endocarditis.

Tricuspid regurgitation may be found in people with a type of congenital heart disease called Ebstein's anomaly.

Other, less common causes of tricuspid regurgitation include:

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

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 regurgitation is not severe. However, patients may have:

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

Exams and Tests

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

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

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

Other tests, such as CT scan or MRI of the chest (heart), may reveal enlargement of the right side of the heart and other changes.

Treatment

Treatment may not be needed if there are few or no symptoms. You may need to go to the hospital to diagnose and treat severe symptoms.

Swelling may be managed with medications (diuretics) that help remove fluids from the body.

Conditions that cause this problem should be identified and treated. Some people may be able to have surgery to repair or replace the tricuspid valve. Surgery is usually done as part of another procedure.

People with abnormal or damaged heart valves are at risk for an infection called endocarditis. Anything that causes bacteria to get into your bloodstream may lead to this infection. Steps to avoid this problem include:

• Avoid unclean injections
• Treat strep infections promptly to prevent rheumatic fever
• Always tell your health care provider and dentist if you have a history of heart valve disease or congenital heart disease before treatment. Guidelines recommend the use of antibiotics for some patients, but only under certain conditions.

Outlook (Prognosis)

Treating any conditions, especially high blood pressure in the lungs and swelling of the right lower heart chamber, may correct this 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, either from this condition or the one that caused it.

Possible Complications

• Cirrhosis
• Endocarditis
• Weight loss
• Worsening of heart failure

When to Contact a Medical Professional

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.

Alternative Names

Tricuspid insufficiency

References

Carabello BA. Valvular heart disease. In: Goldman L, Schafer AI, eds. Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 75.

Nishimura RA, Carabello BA, Faxon DP, et al. ACC/AHA 2008 Guideline update on valvular heart disease: focused update on infective endocarditis: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. J Am Coll Cardiol. 2008;52(8):676-685.

Otto CM, Bonow RO. Valvular heart disease. In: Bonow RO, Mann DL, Zipes DP, Libby P, Braunwald E, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 9th ed. St. Louis, Mo: WB Saunders; 2011:chap 66.

Update Date: 6/4/2012

Updated by: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington, School of Medicine; and Michael A. Chen, MD, PhD, Assistant Professor of Medicine, Division of Cardiology, Harborview Medical Center, University of Washington Medical School, Seattle, Washington. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc.