Symptoms of tricuspid regurgitation

The tricuspid valve can be simply understood as a one-way valve that ensures that blood circulation flows in a certain direction. Tricuspid regurgitation is an incomplete closure that can occur secondary to infective endocarditis during drug injection. Tricuspid regurgitation is extremely harmful. We need to know its symptoms and receive timely treatment when it is discovered. So, what are the symptoms of tricuspid regurgitation? Let’s take a look below.

Aside from symptoms of low output such as fatigue, cool skin, dyspnea, and edema, the only specific symptom of severe TR is a pulsating sensation in the neck due to high jugular venous regurgitation waves transmitted from right ventricular pressure. Discomfort in the right upper abdomen may occur due to liver congestion. As the right atrium enlarges, atrial fibrillation and atrial flutter are common, which further reduce cardiac output and can suddenly induce severe heart failure.

The jugular venous wave may have varying degrees of V wave or Y tilt, depending on the degree of TR. Synchronous with the V wave, the liver has varying degrees of systolic pulsation.

When TR is significant, there is often a systolic murmur and thrill in the right jugular vein. If TR is mild, secondary to pulmonary hypertension, a high-pitched TR murmur can be heard during full systole. If TR is significant and primary, the murmur frequency is medium. The murmur increases during inspiration (Carvallo sign). It is usually clearest in the 4th and 5th intercostal spaces near the sternum or in the upper abdomen. However, if the right ventricle encroaches on the original apex, the murmur is loudest at the apex. If TR is secondary to cor pulmonale caused by emphysema, the murmur can be heard on the free edge of the liver.

The ECG may show varying degrees of RV overload, depending on the severity of TR and whether it is secondary to pulmonary hypertension. There may be tall, peaked P waves and a QR pattern in lead V1. This is typical of right atrial enlargement and RV hypertrophy.

X-rays show widening of the superior vena cava, right atrium enlargement (causing the heart shadow to enlarge to the right) and right ventricle enlargement (causing the heart shadow to enlarge to the left). Lateral chest radiographs may also show right ventricular enlargement.

Echocardiography shows enlarged right atrium and right ventricular diameter. Doppler and two-dimensional echocardiography can confirm this diagnosis. Cardiac catheterization and angiography can directly confirm TR and measure right ventricular pressure, which can determine whether TR is primary or secondary.

treat

Even patients with severe TR can still tolerate it for many years. In heroin addicts, tricuspid valve resection is often required due to infective endocarditis. If TR is due to heart failure, internal and external surgery to treat the cause of heart failure can reduce the amount of reflux. If TR is secondary to pulmonary hypertension and right ventricular hypertension caused by left valvular disease (such as MS), it can be improved through surgical treatment of left valvular disease. During mitral valve surgery, annuloplasty can be used to correct TR at the same time to prevent death from low cardiac output after surgery.