Causes of Tricuspid Regurgitation (TR)

• Functional—secondary to pulmonary hypertension, cor pulmonale, right heart failure (commonest
• Chronic rheumatic heart disease.
• Infective endocarditis (commonly involved in drug addicts).
• Congenital heart disease (e.g. Ebstein’s anomaly).
• Carcinoid syndrome.
• Right ventricular papillary muscle infarction, trauma or steering wheel injury in chest.


• May be asymptomatic. Symptoms of primary disease.


• Pulse—normal in volume, rhythm and character.
• JVP—raised, giant ‘V’ wave, oscillating upto ear lobule.

Precordium Examination:
• On palpation:
–– Left parasternal lift and epigastric pulsation (due to RVH).

• On auscultation:
–– First heart sound—soft in tricuspid area, normal in other areas.
–– Second sound—normal in all the areas.
–– Pan systolic murmur (PSM) in left lower parasternal area with no radiation, louder with

• Others:
–– Liver—enlarged, tender and pulsatile.
–– Occasionally ascites, oedema and pleural effusion may occur in TR.

Cardinal Findings in Tricuspid Regurgitation

• Prominent ‘V’ wave in JVP.
• Pansystolic murmur (PSM) in left lower parasternal area, louder with inspiration and reduced
on expiration.
• Liver—enlarged, tender and pulsatile


• Chest X-ray—heart may be enlarged.
• ECG.
• Echocardiogram, preferably colour Doppler.


• Right-sided heart failure.
• Infective endocarditis.


• Treatment of primary cause.
• In severe organic TR—operative repair. Occasionally, valve replacement is needed.
• Ebstein’s anomaly: It is a congenital heart disease associated with downward displacement
of tricuspid valve into the right ventricle. Hence, right atrium is large and right ventricle is
small. Characteristically, multiple clicks occur due to asynchronous closure of tricuspid valve.
ASD is commonly associated with this anomaly.