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tricuspid regurgitation

Alternative Names
tricuspid insufficiency, tricuspid incompetence

Tricuspid regurgitation occurs when the tricuspid valve within the heart fails to close tightly. This causes blood to flow backward.

What is going on in the body?
There are four chambers in the heart, two on the left side and two on the right. The tricuspid valve separates the upper and lower chambers on the right side of the heart. Failure of this valve to close properly may lead to circulation problems and damage to the heart over time.

What are the signs and symptoms of the disease?
Many people with tricuspid regurgitation have no symptoms. If symptoms do occur, they may include: What are the causes and risks of the disease?
This condition has many causes, including:
  • congenital heart disease, in which the infant is born with an defective tricuspid valve
  • congestive heart failure
  • a heart attack
  • pulmonary hypertension, or high blood pressure in the arteries that carry blood through the lungs
  • rheumatic fever, a condition that may occur as a complication of strep throat
  • infection of the heart valves, called endocarditis. A person who uses intravenous drugs, such as heroin, is at a high risk for this cause of tricuspid valve damage.
  • old age. Tricuspid regurgitation due to ageing is often minimal and usually causes no harm.
  • trauma to the heart, such as from a stab wound to the chest
  • a tumour called a carcinoid tumour
Other causes are also possible.

What can be done to prevent the disease?
Prevention of tricuspid regurgitation is related to the cause. For example, avoiding the use of intravenous drugs can prevent many cases due to heart valve infection. Avoiding smoking could help prevent many cases due to pulmonary hypertension, congestive heart failure, and heart attacks. Many cases cannot be prevented.

How is the disease diagnosed?
Tricuspid regurgitation may be suspected after the history and physical examination. The doctor may hear an abnormal heart sound, called a heart murmur, when listening to the heart with a stethoscope. A heart tracing, called an electrocardiogram or ECG, may reveal certain problems that suggest this condition or one of its causes. A chest x-ray may show certain abnormalities as well.

Blood tests may also be ordered. For example, a blood test called a blood culture is done if an infection of the heart valve is suspected. This test is done to try to identify any bacteria that may be causing the infection.

Echocardiography is the test usually used to confirm the diagnosis. This is an imaging test that uses ultrasound waves to view the heart. This test can show the blood flowing backward through the valve.

A special procedure called a cardiac catheterisation may also be done. This procedure involves inserting a tube though the skin and into a blood vessel, usually in the groin. The tube can then be advanced through the blood vessel into the heart. A contrast agent can be squirted through the tube and pictures taken of the contrast agent while it is inside the heart and main blood vessels. This can help better define the defects in the heart. This test is most useful after a heart attack or when complex birth defects of the heart are suspected.

What are the long-term effects of the disease?
In severe untreated tricuspid regurgitation, the long-term effects may include congestive heart failure, heart and liver damage, and dangerous arrhythmias. Tricuspid regurgitation is often a long-term condition with symptoms that appear slowly over many years. If there are no other heart problems, the person may have no long-term effects.

What are the risks to others?
There are no risks to others, since tricuspid regurgitation is not contagious.

What are the treatments for the disease?
Treatment of the underlying cause of the tricuspid regurgitation may help restore the normal function of the valve. For example, congestive heart failure can be treated with heart medications. Heart valve infections often go away with antibiotics. If there is no underlying disease, treatment may not be needed. This is common in the elderly, who often get mildly leaky valves. Open heart surgery can be used to repair or replace the valve in severe cases.

What are the side effects of the treatments?
Side effects depend on the treatments used. For example, antibiotics may cause allergic reactions or stomach upset. Surgery carries a risk of bleeding, infection, and allergic reactions to anaesthesia.

What happens after treatment for the disease?
If the cause of the tricuspid regurgitation can be treated, the function of the tricuspid valve may return to normal. If there is permanent damage to the valve, closer monitoring is usually needed. Those who have surgery to replace the valve are often "cured" once they recover from surgery.

How is the disease monitored?
Regular visits to the doctor are often advised. Repeat ECGs or echocardiograms may be used to monitor the function of the heart and its valves. Any new or worsening symptoms should be reported to the doctor.

Author: Eric Berlin, MD
Reviewer: HealthAnswers Australia Medical Review Panel
Editor: Dr David Taylor, Chief Medical Officer HealthAnswers Australia
Last Updated: 1/10/2001
Potential conflict of interest information for reviewers available on request

This website and article is not a substitute for independent professional advice. Nothing contained in this website is intended to be used as medical advice and it is not intended to be used to diagnose, treat, cure or prevent any disease, nor should it be used for therapeutic purposes or as a substitute for your own health professional's advice.  All Health and any associated parties do not accept any liability for any injury, loss or damage incurred by use of or reliance on the information.


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