Tricuspid Regurgitation Murmur

Introduction

Tricuspid regurgitation (TR) is a condition where blood flows backward from the right ventricle into the right atrium due to an insufficiently closing tricuspid valve. This can lead to increased pressure in the right atrium and venous congestion.

Causes of Tricuspid Regurgitation

The condition can be classified as: 1. Primary TR – Due to structural damage of the tricuspid valve (e.g., infective endocarditis, rheumatic heart disease, congenital abnormalities). 2. Secondary (or Functional) TR – Due to right ventricular dilation or pulmonary hypertension leading to valve incompetence.

Clinical Features and Murmur

Characteristics of a Tricuspid Regurgitation Murmur:

• Best heard at the left lower sternal border.
• Holosystolic murmur (heard throughout systole).
• Increases with inspiration due to increased venous return to the right heart (Carvallo’s sign).
• Soft or absent in mild cases but can be loud in severe TR.
• Often associated with jugular venous distension (JVD) and hepatic pulsations.

Diagnosis

• Physical Examination: Murmur characteristics, JVD, peripheral edema.
• Echocardiography: The key imaging tool to assess valvular anatomy and function.
• ECG & Chest X-ray: Can show associated right atrial or ventricular enlargement.
• Cardiac MRI: For further detailed evaluation if needed.

Management

Medical Management:

• Treat underlying causes, such as pulmonary hypertension or left heart disease.
• Diuretics can help reduce volume overload symptoms.

Surgical or Interventional Options:

• Valve repair or replacement is considered in severe cases, especially if symptomatic or associated with significant right ventricular dysfunction.

Conclusion

Tricuspid regurgitation is often underdiagnosed but can significantly impact heart function, particularly in severe cases. A careful physical exam, echocardiography, and addressing underlying pathologies are key to management.

Source recommendations

1. American College of Cardiology/American Heart Association Guidelines for the Management of Valvular Heart Disease

1. https://www.ahajournals.org/doi/10.1161/CIR.0000000000000923
2. https://www.acc.org/Latest-in-Cardiology/ten-points-to-remember/2020/12/16/21/58/2020-ACC-AHA-VHD-GL-Pt-1-GL-VHD
3. https://pubmed.ncbi.nlm.nih.gov/33332149/
4. https://www.acc.org/Latest-in-Cardiology/ten-points-to-remember/2024/03/13/18/13/2024-acc-aha-clinical-performance-valvular
5. https://pubmed.ncbi.nlm.nih.gov/9809971/

2. European Society of Cardiology Guidelines for the Management of Valvular Heart Disease

1. https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Valvular-Heart-Disease-Guidelines
2. https://academic.oup.com/eurheartj/article/43/7/561/6358470
3. https://pubmed.ncbi.nlm.nih.gov/34453165/
4. https://eurointervention.pcronline.com/article/2021-esc-eacts-guidelines-for-the-management-of-valvular-heart-disease
5. https://www.ahajournals.org/doi/10.1161/CIR.0000000000000923