Tricuspid Insufficiency
In tricuspid insufficiency, also known as tricuspid regurgitation, an incompetent tricuspid valve allows blood to flow back into the right atrium during systole, decreasing blood flow to the lungs and the left side of the heart. Cardiac output also decreases.
Causes
Tricuspid insufficiency results from marked dilation of the right ventricle and tricuspid valve ring. It most commonly occurs in the late stages of heart failure because of rheumatic or congenital heart disease.
Less commonly, it results from congenitally deformed tricuspid valves, atrioventricular canal defects, or Ebstein’s anomaly of the tricuspid valve. Other causes include infarction of the right ventricular papillary muscles, tricuspid valve prolapse, carcinoid heart disease, endomyocardial fibrosis, infective endocarditis, and trauma.
Complications
Fluid overload in the right side of the heart can lead to right-sided heart failure.
Assessment
The patient may have a history of a disorder that can cause tricuspid insufficiency.
The patient may complain of dyspnea, fatigue, weakness, and syncope. Peripheral edema may cause him discomfort.
Inspection may reveal jugular vein distention with prominent v waves in a patient with normal sinus rhythm. In severe tricuspid insufficiency that has progressed to right-sided heart failure, the patient may appear jaundiced, with severe peripheral edema and ascites. He may also appear malnourished.
Auscultation may disclose a blowing holosystolic murmur at the lower left sternal border that increases with inspiration and decreases with expiration and Valsalva’s maneuver.
Palpation may reveal hepatomegaly (when the patient has right-sided heart failure), systolic pulsations of the liver, and a positive hepatojugular reflex. You also may feel a prominent right ventricular pulsation along the left parasternal region.
