Tricuspid regurgitation 1.

Etiology
an
Infective
endocarditis. In drug abuserwho inject
drugs under septic conditions, infective
endocarditis is a common cause of
tricuspid regurgitation.b. Right ventricular
failure. Sustained pressure or volume
overload on the right ventricle leads to
right ventricular dilatation and improper
alignment of the papillary muscles, which
produces
tricuspid
regurgitation.c.
Rheumatic heart disease. In rheumatic
heart disease, tricuspid regurgitation may
occur, secondary to right ventricular
pressure overload from left-sided valvular
lesions. Tricuspid regurgitation also may
occur as a result ot primary rheumatic
involvement of the tricuspid valve.2Pathophysio.
During
systole,
the
dysfunctioning tricuspid valve allows
blood to flow backward into the right
atrium, leading to systemic venous
congestion and venous hypretension
3.Clinical features a.
Symptoms. Rightsided failure (i.e., edema, ascites) occurs.
In severe and acute cases, hepatic
congestion may be extensive enough to
produce right upper quadrant pain.Passive
hepatic congestion also may lead to
hepatocel-ilar damage and jaundice.
b.Physical signs (1)Right ventricular lift. The
enlarged right ventricle may be palpated
as a systolic lift of the sternum.
(2)Murmur. A holosystolic murmur that
increases with inspiration is heard along
theleft
sternal
border.
(3) jugular venous pulsation. A large v wave
is seen in jugular.
veins
during
systole.(4)Pulsatile
liver.
Systolic
expansion of the liver frequently is
present. 4.Diagnosis
a.
Chest
radiography shows right ventricular
enlargement as an obliteration of the
retrosternal airspace on the lateral view.
bechocardiogr:
demonstrate
enlargement of the right atrium & right
ventricle. Doppler examination is highly
effective in demonstrating tricuspid
regurgitation.5.Therapy. Left-sided failure
frequently is the cause of right- sided
failure & tricuspid regurgitation. Effective
treatment of left-sided failure reduce s
right ventricular pressure overload, which
may decrease right ventricular size, thus
restoring valvular competence If
tricuspid regurgitation is caused by
organic valvular disease, surgical repair
or replacement of the tricuspid valve may
be necessary.