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Tricuspid regurgitation

Blood that flows between different chambers of your heart must flow through a heart valve. These valves open up enough so that blood can flow through. They then close, keeping blood from flowing backward.

The tricuspid valve separates the right lower heart chamber (the right ventricle) from the right upper heart chamber (right atrium).

Tricuspid regurgitation is a disorder in which this valve does not close tight enough. This problem causes blood to flow backward into the right upper heart chamber (atrium) when the right lower heart chamber (ventricle) contracts.

Tricuspid Regurgitation

Alternative Names

Tricuspid insufficiency

Causes

An increase in size of the right ventricle is the most common cause of this condition. The right ventricle pumps blood to the lungs where it picks up oxygen. Any condition that puts extra strain on this chamber can cause it to enlarge.

Tricuspid Regurgitation

Tricuspid regurgitation may also be caused or worsened by infections, such as:

  • Rheumatic fever
  • Infection of the tricuspid heart valve, which causes damage
Ebstein's anomaly

Less common causes of tricuspid regurgitation include:

  • A type of heart defect present at birth called Ebstein anomaly
  • Carcinoid tumors, which release a hormone that damages the valve
  • Marfan syndrome
  • Rheumatoid arthritis
  • Radiation therapy
  • Past use of a diet pill called "Fen-Phen" (phentermine and fenfluramine) or dexfenfluramine. The drug was removed from the market in 1997.

Symptoms

Mild tricuspid regurgitation may not cause any symptoms. Symptoms of heart failure may occur, and can include:

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 buildup 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 medicines that help remove fluids from the body (diuretics).

Some people may be able to have surgery to repair or replace the tricuspid valve. Surgery is usually done as part of another procedure.

Treatment of certain conditions may correct this disorder. These include:

  • High blood pressure in the lungs
  • Swelling of the right lower heart chamber

Outlook (Prognosis)

Surgical valve repair or replacement usually provides a cure.

The outlook is poor for people who have severe tricuspid regurgitation that cannot be corrected.

When to Contact a Medical Professional

Call your health care provider if you have symptoms of tricuspid regurgitation.

Prevention

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. Some people may need to take antibiotics before having a procedure.

Prompt treatment of disorders that can cause valve disease reduces your risk of tricuspid regurgitation.

References

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

Nishimura. RA, Otto CM, Bownow RO et al. 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Thorac Cardiovasc Surg. 2014;148(1):e1-e132.

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.

Updated: 5/13/2014

Michael A. Chen, MD, PhD, Associate Professor of Medicine, Division of Cardiology, Harborview Medical Center, University of Washington Medical School, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.


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