Tricuspid regurgitation is caused by disorders that enlarge the right ventricle.
Symptoms are vague, such as weakness and fatigue.
Doctors make the diagnosis because of physical examination findings, and they use echocardiography to confirm the diagnosis.
The underlying disorder is treated.
(See also Overview of Heart Valve Disorders Overview of Heart Valve Disorders Heart valves regulate the flow of blood through the heart's four chambers—two small, round upper chambers (atria) and two larger, cone-shaped lower chambers (ventricles). Each ventricle has... read more and the video .)
The tricuspid valve is in the opening between the right atrium and the right ventricle. The tricuspid valve opens to allow blood from the right atrium to fill the right ventricle and closes to keep blood from flowing back into the right atrium as the right ventricle contracts to pump blood into the lungs. When the tricuspid valve does not close completely, some blood leaks backward into the right atrium, termed regurgitation. (See also the video .)
Blood leaking backward into the right atrium increases the volume of blood there and results in less blood being pumped through the heart and to the body. As a result, the right atrium enlarges, and blood pressure increases in the right atrium and the large veins that enter it from the body. All of these changes can sometimes contribute to symptoms of heart failure Heart Failure (HF) Heart failure is a disorder in which the heart is unable to keep up with the demands of the body, leading to reduced blood flow, back-up (congestion) of blood in the veins and lungs, and/or... read more . The liver and/or legs may swell because of this increased pressure.
An extremely enlarged atrium often beats rapidly in an irregular pattern (a disorder called atrial fibrillation Atrial Fibrillation and Atrial Flutter Atrial fibrillation and atrial flutter are very fast electrical discharge patterns that make the atria (upper chambers of the heart) contract very rapidly, with some of the electrical impulses... read more ), which reduces the heart's pumping efficiency because the fibrillating atrium is quivering rather than pumping. Consequently, blood does not flow through the atrium briskly, and blood clots may form inside the chamber. If a clot breaks loose (becoming an embolus), it is pumped out of the heart and may block an artery, possibly causing a stroke Overview of Stroke A stroke occurs when an artery to the brain becomes blocked or ruptures, resulting in death of an area of brain tissue due to loss of its blood supply (cerebral infarction). Symptoms occur suddenly... read more or other damage.
Causes of Tricuspid Regurgitation
Unlike other heart valve disorders Overview of Heart Valve Disorders Heart valves regulate the flow of blood through the heart's four chambers—two small, round upper chambers (atria) and two larger, cone-shaped lower chambers (ventricles). Each ventricle has... read more , tricuspid regurgitation usually occurs in a normal valve that has been affected by other heart disorders. The most common cause is when the right ventricle enlarges and resistance to blood flow from the right ventricle to the lungs is increased. Resistance may be increased by
Severe, long-standing lung disorders, such as emphysema Chronic Obstructive Pulmonary Disease (COPD) Chronic obstructive pulmonary disease is persistent narrowing (blocking, or obstruction) of the airways occurring with emphysema, chronic obstructive bronchitis, or both disorders. Cigarette... read more or pulmonary hypertension Pulmonary Hypertension Pulmonary hypertension is a condition in which blood pressure in the arteries of the lungs (the pulmonary arteries) is abnormally high. Many disorders can cause pulmonary hypertension. People... read more
To compensate, the right ventricle enlarges, stretching the tricuspid valve and causing regurgitation.
Other, less common causes are infection of the heart valves (infective endocarditis Infective Endocarditis Infective endocarditis is an infection of the lining of the heart (endocardium) and usually also of the heart valves. Infective endocarditis occurs when bacteria enter the bloodstream and travel... read more ) most often due to intravenous injection of illicit drugs, birth defects of the tricuspid valve, injury, rheumatic fever Rheumatic Fever Rheumatic fever is inflammation of the joints, heart, skin, and nervous system, resulting from a complication of untreated streptococcal infection of the throat. Rheumatic fever is a reaction... read more , and weakness of the mitral valve tissue (myxomatous degeneration).
Symptoms of Tricuspid Regurgitation
Tricuspid regurgitation usually causes no symptoms except sometimes pulsations in the neck due to the elevated right atrial pressure and discomfort in the right upper part of the abdomen due to an enlarged liver. Rarely, people have accumulation of fluid in the body (edema), mainly in the legs.
Diagnosis of Tricuspid Regurgitation
The diagnosis is based on the person's medical history and the results of a physical examination. Through a stethoscope, doctors may hear a characteristic murmur (abnormal heart sounds that a doctor can hear with a stethoscope) produced by the blood leaking backward through the tricuspid valve, but the murmur tends to disappear as the regurgitation worsens.
Often electrocardiography Electrocardiography Electrocardiography (ECG) is a quick, simple, painless medical test that measures the heart’s electrical impulses. During an ECG, the heart's electrical impulses are measured, amplified, and... read more (ECG), and a chest x-ray are done. Other tests (such as magnetic resonance imaging or cardiac catheterization) may be done, depending on the severity of tricuspid regurgitation observed with echocardiography.
Echocardiography Echocardiography and Other Ultrasound Procedures Ultrasonography is a type of medical imaging that uses high-frequency (ultrasound) waves to produce a moving image of internal organs and other tissues. Echocardiography is ultrasonography of... read more can produce an image of the leaky valve and show the amount of blood leaking, so that the severity of the regurgitation can be determined.
Treatment of Tricuspid Regurgitation
Treatment of underlying disorder
Sometimes valve repair or replacement
Usually, mild tricuspid regurgitation requires little or no treatment. However, the underlying disorder, such as emphysema, pulmonary hypertension, pulmonic stenosis, or abnormalities of the left side of the heart, is likely to require treatment. Treatment of atrial fibrillation and heart failure is also necessary.
Surgery to repair or replace the tricuspid valve is rarely done unless regurgitation is severe or surgery on another heart valve (for example, mitral valve replacement) is also needed. Surgery may involve sewing in a ring to reduce the size of the valve opening, repairing the valve, or replacing it with a prosthetic valve.
Prognosis for Tricuspid Regurgitation
Although people may tolerate tricuspid regurgitation for years, the outlook is poor when tricuspid regurgitation is severe. The additional blood in the ventricle eventually causes heart failure Heart Failure (HF) Heart failure is a disorder in which the heart is unable to keep up with the demands of the body, leading to reduced blood flow, back-up (congestion) of blood in the veins and lungs, and/or... read more . There is no good way to identify heart failure early, so valve repair or replacement may not be done early enough to prevent lasting damage. The surgery itself presents significant risks, so the overall outcome is poor.
The following English-language resource may be useful. Please note that THE MANUAL is not responsible for the content of this resource.
American Heart Association: Heart Valve Disease: Provides comprehensive information on diagnosis and treatment of diseases of the heart valves