Internal Medicine

0521779407-20 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:22

Tricuspid Valve Insufficiency (TR) 1449

■Holosystolic murmur right sternal border, which may increase with

inspiration

■Right ventricular S3

■Elevated JVP with prominent V wave

■Enlarged pulsatile liver

■Ascites

■Edema

tests

■ECG

➣Right atrial abnormality

➣Right ventricular hypertrophy

➣Right axis deviation

➣Atrial fibrillation

■Chest X-Ray

➣Enlarged right ventricle

➣Enlarged right atrium

➣Dilated superior vena cava and azygos veins

■Echo/Doppler (most important)

➣Detect and quantitate TR

➣Assess pulmonary artery pressure and other conditions which

may cause TR: left ventricular dysfunction, mitral stenosis

■Cardiac Catheterization

➣Limited role in assessing primary TR

Measure pulmonary artery pressure (< 40 mm Hg suggests pri-

mary TR)

Right atrial and right ventricular diastolic pressures elevated

➣Major role in assessing conditions which may cause right ven-

tricular dilation and TR

differential diagnosis

■Pericardial effusion/tamponade

■Aortic stenosis

management

■Secondary TR

➣Treatment of primary condition

■Primary TR

➣Medical – diuretics

➣Surgery – most cases with primary TR, valve surgery not

necessary; severe/poorly tolerated TR with medical therapy, tri-

cuspid valve repair with annuloplasty ring